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National Nursing Week Special Pull Out Section FOCUS IN THIS ISSUE

SURGICAL PROCEDURES/ TRANSPLANTS/ ORTHOPEDICS/REHAB:

Canada's Health Care Newspaper MAY 2014 | VOLUME 27 ISSUE 5 | www.hospitalnews.com

Non-invasive surgery, plastic surgery, orthopedic surgery and new surgical techniques.Organ donation and transplantation procedures. Advances in treatment of renal disease including home peritoneal dialysis, hemodialysis and renal transplantation. Rehabilitation techniques for a variety of injuries and diseases.

Integrating iDevices with rehabilitation

INSIDE Ethics ..................................................13 Data Pulse .......................................... 14 From the CEO's desk..........................15 Travel ................................................... 17 Careers ...............................................23

The determination of death

and organ donation By Dr. Sam Shemie

Recent coverage in the media on death determination and organ donation has left some Canadians with the false impression that there is an unclear understanding of death in this country. Inferences were made that donation and transplantation procedures occur before a donor has actually died, and their family members are being misled to think otherwise. This is simply not true. Continued on page 18

A round of applause

to our Care Coordinators and Registered Nurses THANK YOU for ensuring access to the right care

As we celebrate Nursing Week, we recognize the efforts of our 3,500 Care Coordinators – Registered Nurses, Occupational Therapists, Physiotherapists, Registered Dietitians, Social Workers and SpeechLanguage Pathologists – and every other member of our team in meeting our clients’ needs. You work tirelessly to ensure that people get the right care – at home, at school and in the community. On behalf of the 637,000 Ontarians we serve each year, thank you! For more details, or to apply for a Care Coordinator or clinical care delivery role, visit ccacjobs.ca. Most Community Care Access Centres of Ontario are governed by the requirements of the French Language Services Act. We provide services in French and encourage applications from bilingual candidates.

We are committed to accommodating people with disabilities as part of our hiring process. If you have any special requirements during the recruitment process, please advise Human Resources.

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In Brief

Aspirin before surgery ineffective Kingston General Hospital (KGH) and Queen’s University researchers are part of a groundbreaking international study that has shown that starting – or continuing – to take Aspirin before noncardiac surgery as a way to protect the heart after surgery is ineffective and, in some cases, harmful. Because surgery puts patients at increased risk of heart attack, doctors often continue to administer low doses of Aspirin before and after non-cardiac procedures. But new data from the PeriOperative Ischemic Evaluation Study (POISE-2), published in the New England Journal of Medicine, shows that administering Aspirin provided no benefit in reducing the risk of heart-related complications after surgery. Quick Facts about the study: • POISE-2 is a large, international, placebo-controlled factorial trial. • Half of the participating patients were either started on Aspirin or received their usual daily Aspirin before their surgery, while the other half were given a placebo. • Researchers determined that 7 per cent of those in the Aspirin group had a heart attack or died within 30 days of surgery, compared to 7.1 per cent of those who received a placebo. • Meanwhile, more patients in the Aspirin group experienced significant bleeding (4.6 per cent) compared to the placebo group (3.8 per cent). • Clonidine, a drug given to control heart rate and blood pressure, was also shown to be ineffective at reducing cardiovascular complications associated with surgery. This was the subject of a second article published in the same issue of the New England Journal of Medicine with contributions from the KGH team. • Up to 200 million people undergo major non-cardiac surgery each year, and 10 million of those experience a major heart-related complication. • The most common surgeries in the study were orthopedic procedures such H as joint replacements. n

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Nurse Practitioners

create health care team cohesion The aim of the Nurse Practitioner, Practice Integration Outcomes Study is to foster a greater understanding of the nurse practitioners' practices in Ontario that contribute to interprofessional collaboration among nurses, doctors,

Quick Facts

•The Nurse Practitioner Practice, Integration and Outcomes Study is funded by the Ontario Ministry of Health and Long-term Care •The Study is designed to explore nurse practitioners' practices within a health care professional team setting •The study also included a nurse

and other providers for the purpose of providing high quality, timely and safe care to hospitalized patients and long term care residents. The study revealed a number of important findings. Nurse Practitioners in practitioner self-assessment survey of 149 nurses, conducting interviews with 52 health care professionals, in 10 different health care professions •The study encompassed professional third party observations of 24 nurse practitioners in regions across Ontario in both hospital and long term care settings

acute and long term care facilities reported full engagement in interprofessional care, and said they could increase their activities of interdependence to enhance the provision of health services to patients. The study further found that Nurse Practitioners are consistent, available, peacemakers who bridge professions and focus on patient care. One additional finding was that Nurse Practitioners use three forms of interacting which include: "brief knotworking" to build and share information, "rapid knotworking" to promote collaboration, negotiation and delegation and they are initiators of social interactions that build trust and foster professional H relationships. n

Barely half of potential organ donors become donors New performance data reported by Trillium Gift of Life Network (TGLN) shows there are opportunities for both hospitals and Ontarians to play a role when it comes to increasing the number of lives saved through organ and tissue donation in Ontario. From April 1 to December 31, 2013, 42 designated hospitals in Ontario reported an average of 93 per cent of potential organ and tissue donation cases to TGLN. During the same period, only 52 per cent of potential donation cases became organ donors, referred to as conversion rate. "TGLN is committed to working closely with our hospital partners to improve donation rates by helping them implement best practices and ensure timely referral of potential donation cases," says Ronnie Gavsie, President and CEO of TGLN. "TGLN is also working to increase consent to organ donation by ensuring well trained TGLN staff approach families to discuss donation." Focus is being placed on the Greater Toronto Area (GTA) as conversion rates at the majority of hospitals in this part of the province have historically been below average. Steps are being taken to improve performance of both hospitals and TGLN. These include: •Designating a physician at each hospital

to work with TGLN to ensure integration of donation best practices with end-of-life care, starting with GTA hospitals; •Implementation of a new referral process with CritiCall Ontario and Neurosurgery Ontario to ensure potential organ do-

nors are identified and referred in a timely manner; and, •Enhanced diversity training for TGLN staff to better meet the needs of Ontario families when discussing organ and tissue H donation. n

Strengthening clinical trials The Government of Canada announced the creation of the Canadian Clinical Trials Coordinating Centre (CCTCC) – a collaborative effort of the Canadian Institutes of Health Research (CIHR), Canada's Research-Based Pharmaceutical Companies (Rx&D), and the merged organizations of the Association of Canadian Academic Healthcare Organizations and the Canadian Healthcare Association (ACAHO/CHA). Clinical trials involve testing new therapies with patients. They are a critical step toward bringing new medicines, effective vaccines, and innovative medical devices safely to market. They can result in better medical treatments, bet-

ter quality of life, cost savings to Canada's health system, new jobs, and revenue for the Canadian economy. Most importantly, clinical trials have the potential to relieve pain and suffering, and to reverse or halt the effects of disease or disability for Canadian patients. The CCTCC will improve the coordination of clinical trial activities and streamline regulatory processes for companies and researchers. This will be achieved by implementing the recommendations produced by an extensive stakeholder consultation. Those recommendations were summarized in the report To Your Health and Prosperity – An Action Plan to Help Attract More H Clinical Trials to Canada. n

provides safety guidance for diagnostic, cosmetic, preventative, and therapeutic applications, as well as requirements for

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MAY 2014 HOSPITAL NEWS


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Guest Editorial

UPCOMING DEADLINES JUNE 2014 ISSUE EDITORIAL MAY 7 ADVERTISING: DISPLAY MAY 23 CAREER MAY 27 MONTHLY FOCUS: Oncology/Medical Imaging/Pediatrics: Approaches to cancer treatment, diagnosis and prevention. A look at medical imaging techniques for diagnosis, treatment and prevention of diseases. Pediatric programs and developments in the treatment of pediatric disorders including autism.

JULY 2014 ISSUE EDITORIAL JUNE 6 ADVERTISING: DISPLAY JUNE 20 CAREER JUNE 24 MONTHLY FOCUS: Cardiovascular Care/Respirology/ Diabetes/Gastroenterology: Developments in the prevention and treatment of vascular disease including cardiac surgery, diagnostic and interventional procedures. Advances in treatment for various respiratory disorders including asthma, allergies. Prevention, treatment and long term management of diabetes and other endocrine disorders. Advances in diagnosis and treatment of diseases of the gastrointestinal tract.

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Organ donation a rare opportunity By Danielle Milley

rgan and tissue donation is a vital part of saving and enhancing thousands of lives each year. Yet many people – including health care professionals – are not aware of the processes that enable giving the gift of life. Just two to three per cent of hospital deaths occur in circumstances that allow for the potential of organ donation. To be a potential donor, one must be on a ventilator at end-of-life. The opportunity for donation is rare. “Our goal is to ensure that at end-oflife, all opportunities for organ and tissue donation are identified and pursued – saving and enhancing as many lives as possible” says Ronnie Gavsie, President and CEO of Trillium Gift of Life Network. “Every family has the right to make a decision on whether to consent to their loved one giving the gift of life. It is our obligation to ensure that right is respected.” Trillium Gift of Life Network (TGLN) is the provincial agency responsible for planning, promoting, co-ordinating and supporting organ and tissue donation and transplantation across Ontario. One way TGLN is ensuring every opportunity is identified is by working with hospital partners who are required to report every patient death or imminent death to TGLN. There are currently 54 hospitals across the province reporting to TGLN. “While we depend on our hospital partners to notify us of potential donors, the primary responsibility of every hospital and every physician is to ensure all lifesaving treatments have

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been exhausted before end-of-life considerations and organ donation is even considered,” says Dr. Sonny Dhanani, TGLN’s Chief Medical Officer, Donation, and an intensivist at the Children’s Hospital of Eastern Ontario. “The patient’s care team is completely separate from the transplant team and never knows the registration status of any patient they are treating.”

Just two to three per cent of hospital deaths occur in circumstances that allow for the potential of organ donation. For many donor families, organ and tissue donation brings a tremendous source of pride and some sense of comfort in a time of sorrow. Heather Higgins and her siblings were faced with that decision a few years ago after they got the call that their father, Malcolm Higgins, had been in a car crash. They were fortunate enough to know what their father’s end-of-life wishes were, because he had spoken with each of his four children about the importance of donation when they turned 16 and were able to register as organ and tissue donors themselves. After learning their father’s prognosis, they were

approached by of one TGLN’s highly trained organ and tissue donation coordinators (OTDC) and asked to consider organ and tissue donation. OTDCs are available either onsite at the hospital or by phone to support families through the donation process, as well as to help facilitate the donation process. An OTDC spoke with Heather and her siblings at the time of their father’s death. “He was really sympathetic and answered all of our questions. He explained the donation process to us and shared with us that three people would be receiving the gift of life from my dad,” says Higgins. “It was one of the worst days of our lives, but knowing that others would be receiving some of the best news of theirs brought some comfort to us.” Last year in Ontario, more than 225 deceased donors gave the gift of life to 992 people. But still every three days someone dies waiting because there are not enough organs to meet the need. You can help by registering consent to organ and tissue donation. Evidence shows when families are presented with proof of registration they overwhelmingly consent to donation, but in the absence of registration, consent drops dramatically. You can register at www.beadonor. ca, at a ServiceOntario centre or by mailing a Gift of Life consent form to H ServiceOntario. n Danielle Milley is a Media Relations Advisor at Trillium Gift of Life Network.

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ADVISORY BOARD Jonathan E. Prousky,

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Senior Communications Specialist Rouge Valley Health System

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers. Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: subscriptions@hospitalnews.com Canadian Publications mail sales product agreement number 40065412.

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Vest helps rehabilitate after mild brain injuries By Anne Kay

t is common for people with a mild traumatic brain injury (mTBI) to feel anxious and unsettled, often having trouble judging distances. “We think this is because some patients have difficulty sensing where their body is in space and they have to work hard to negotiate their environment,” explains physiotherapist Shannon McGuire from the acquired brain injury (ABI) program at St. Joseph’s Parkwood Hospital. “They become overwhelmed and anxious because their brain is having trouble processing sensory information.” Now, at Parkwood Hospital a speciallydesigned vest that combines weights and compression is helping patients with a mTBI know where their body is in space. It is helping them with balance, anxiety, fatigue, attention, concentration, and easing overstimulation in busy environments. Not only are therapists at Parkwood Hospital forerunners in exploring the effectiveness of these vests, they are also enhancing the vests currently available in the marketplace by improving the fit and adding weights. Linda DeGroot, a patient with a mTBI, felt an immediate transformation when she put the vest on. “It was the first time

I

I’d felt secure since sustaining the mTBI,” says Linda, a teacher who sustained a concussion when she hit her head on the ice while playing hockey.

At Parkwood Hospital a specially-designed vest that combines weights and compression is helping patients with a mTBI know where their body is in space. When Linda first came to Parkwood, she was experiencing tremendous levels of anxiety. As a result of her concussion she couldn’t drive her car, go to work, attend church or do many of the things she loved. For a woman used to being independent, Linda was suddenly very dependent on others. After brainstorming other treatments

for Linda, Shannon and her colleagues came up with the idea of using a compression vest. “Once I put the vest on, it was almost an immediate transformation,” says Linda. “It was the first time I’d felt secure since sustaining the mTBI.” “The vest fits snugly to the body–it feels like it’s giving you a big hug,” says Shannon. “We believe the weight combined with compression helps patients feel more grounded.” At first, Linda wore the vest whenever she left the house, but she has progressed so well that now she only wears it when she is in situations with a lot of new stimuli. After seeing Linda’s success with the compression vest, the ABI outpatient team began introducing it to other patients with similar results. Shannon conducted pilot research with Physiotherapy students at Western University on the clinical impact of the compression vests for patients with a mTBI, and is now extending that research to gauge the impact of adding weight to the H vest. n Anne Kay is a Communication Consultant at St. Joseph’s Health Care London.

Wearing the weighted compression vest Linda DeGroot, right, practices balancing with the help of physiotherapist Shannon McGuire.

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The right fit. MAY 2014 HOSPITAL NEWS


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New program helps patients prepare for

shoulder surgery By Akilah Dressekie

new prehabilitation program at Rouge Valley Health System (RVHS) is improving outcomes for shoulder surgery patients by strengthening them before their procedures. The shoulder prehabilitation program, or “prehab” as it is nicknamed, is a one-hour education session for patients preparing to have shoulder surgery at the Rouge Valley Ajax and Pickering (RVAP) hospital campus.

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The focus of prehab is on educating patients about how to best care for their shoulder after surgery, and to encourage a safe and quicker recovery. It was introduced in March for the patients of Rouge Valley shoulder specialists Dr. Stephen Gallay and Dr. Joel Lobo. The class, led by a nurse and physiotherapist, teaches patients what to expect before, during, and after their shoulder surgery.

Various topics are covered during the education sessions including: how to properly apply a shoulder sling; which exercises they can do immediately after shoulder surgery; and how to do each exercise. By helping patients to become better prepared for their surgery, and providing physiotherapy support prior to surgery, the shoulder prehab is expected to improve the patient’s recovery. In addition, it helps bridge any delay, which might occur between the day of surgery and the start of formal physiotherapy. So far, 20 patients have already gone through the program with positive results. “Our shoulder prehab program has helped to alleviate patient anxiety, from the time they enter the operating room, to the time they see a physiotherapist,” explains Amber Curry, surgical manager, RVAP. “Due to the nature of shoulder surgeries, many patients have to be extremely cautious after their procedure. With this program, they can become more educated on how to care for their shoulder, which can result in a safer, better and quicker recovery.” RVHS already has a very successful prehab program for hip and knee replacement patients, which includes an education and

pre-conditioning component. It helps patients become better educated about what to expect out of their hip or knee replacement surgery, and gets them in better physical condition before the procedure. The focus of prehab is on educating patients about how to best care for their shoulder after surgery, and to encourage a safe and quicker recovery.

Patient finds program “very helpful”

The majority of shoulder surgery patients have a problem with their rotator cuff. These patients typically live very active lives. Learning how to care for their shoulder after surgery greatly improves their recovery. David Leithead, 64, had surgery on his right shoulder to relieve intense pain he had for 18 months. The pain was preventing him from playing baseball and pickleball (a combination of badminton, tennis, and Ping-Pong). “I tried to play baseball, but I couldn’t throw overhand because the pain was so bad,” he explains. After a cortisone injection didn’t relieve David’s pain, he was referred to Dr. Gallay, who diagnosed him with rotator cuff impingement syndrome. David was promptly

scheduled for outpatient arthroscopic subacromial decompression surgery. The surgery was performed successfully in April at RVAP, only four weeks after his initial consultation with the surgeon. David was fortunate to be in one of the first groups of patients to move through the shoulder prehab program. “I found that prehab was very helpful for me. It helped to prepare me for the surgery. The booklet and education session showed me what exercises to do, so that I could get started right away.” David, who is now doing physiotherapy, has also started doing exercises he learned in prehab at home every day H for 20 minutes. n Akilah Dressekie is a Senior Communications Specialist at Rouge Valley Health System.

“It’s my pleasure to say ‘thank you.’ Your knowledge and confidence guided us through all the time. You were like the light and the hope in the dark, especially in the first couple of years. I am glad it is over, successfully. Thank you.” – A.W.

HOSPITAL NEWS MAY 2014

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At the forefront of technology:

Sialendoscopy By Zita Taksas-Raponi ights, camera, action! October 25th was a very exciting day at Halton Healthcare Services (HHS). A camera crew, set up in the operating room at Oakville-Trafalgar Memorial Hospital (OTMH) filmed Dr. Jack Kolenda, HHS Otolaryngologist and Surgeon performing an innovative technique to remove salivary gland stones and blockages. This cutting-edge surgical procedure, called Sialendoscopy, was broadcast live across North America to an international conference on minimally invasive procedures in Colorado, USA where otolaryngologists and surgeons from around the world could watch this educational session. Dr. Kolenda explains that stones, strictures or stenosis (narrowing of the ducts) can form inside the salivary ducts of the glands. This in turn, can block the normal flow of saliva into the mouth and cause inflammation of the glands resulting in pain and possible infection. “While we do not know the exact cause of these obstructions, those who are affected are generally left with recurring infections and pain, which can be quite severe,” continues Dr. Kolenda. “To-date, traditional surgical treatments have involved removing the entire effected salivary gland. Risk of these procedures include scarring, facial nerve paralysis, altered taste sensation of the tongue and a condition known as Frey’s syndrome which is sweating of the face when eating.” “The salivary glands play an important

L

Where are your salivary glands?

The salivary glands are located along the inside of the cheeks by your ear (parotid) and deep within the floor of the mouth (submandibular and sublingual glands).

What do salivary glands do?

These glands produce saliva in response to smell and taste sensations so you can chew your food. The saliva helps break down starches in your diet.

What are salivary stones?

Salivary stones form when chemicals from the saliva accumulate in the duct or the gland.

What causes salivary stones?

role in our health. These glands produce saliva so you can chew your food,” explains Dr. Kolenda. “Without them you would have difficulty swallowing and suffer from a constant dryness and discomfort in your mouth.” “Sialendoscopy allows us to remove the obstruction and keep the gland intact. Since there is no incision, there is no facial scarring or nerve damage and the recovery time is minimal,” explains Dr. Kolenda. “The procedure is done on a day surgery basis at OTMH.” “We insert a tiny scope into the gland so we can explore the salivary ductal system, locate the stone and then, using micro instruments, we remove the stone,” explains Dr. Kolenda. “While it may sound simple, the salivary ducts are delicate microscopic structures. The challenge of performing this procedure is reaching and opening these ducts, and then keeping them dilated while we work to extract the stones.” Dr. Kolenda’s live demonstration also introduced the new instrumentation he has developed with the support of Cook Medical to enhance access to these microscopic ducts. Known as “the Kolendas”, these disposable instruments include dilators that open the ducts as well as sheaths that help create working channels through which the surgeon can execute this microscopic procedure, using multiple instruments. Today, Dr. Kolenda’s instruments are used world-wide by surgeons who perform this surgical technique. Sialendoscopy is still new and evolving. Introduced by Dr. Francis Marchal at the University of Geneva, Switzerland it is considered as one of the most fascinating innovations in the field of OtolaryngologyHead and Neck Surgery in the last decade.

Dr. Kolenda was the first Canadian Surgeon to attend the first international Sialendoscopy hands-on course that took place in Geneva, January 2002. Subsequent to his training, he was the first surgeon to pioneer this innovative procedure both in North America and Canada. Even today, Dr. Kolenda is only one of three surgeons who currently performs this procedure in Canada. Dr. Kolenda continues to collaborate with Cook Medical on the development of a number of other new instruments to further enhance the Sialendoscopy procedure, including a stone breaker which

is currently patent pending and awaiting FDA as well as Health Canada approval. “A microscopic jackhammer that can break the larger salivary stones down using kinetic energy will be invaluable in situations when the stones are larger than the salivary ducts,” concludes Dr. Kolenda. “We are at the forefront of this Sialendoscopy technology and once these new products are released OTMH will be the first hospital to offer these innovative new H procedures.” n Zita Taksas-Raponi is a public relations officer at Halton Healthcare Services.

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While the exact cause of salivary stones is not known, factors which can contribute to the development of salivary stones include: • Dehydration • Poor nutrition • Certain medications such as antihistamines, or those prescribed for blood pressure, psychiatric drugs or bladder control • Trauma to salivary glands www.hospitalnews.com

Dr. Jack Kolenda has been performing a cutting edge surgical procedure called Sialendoscopy.

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From caregiver to patient By Danielle Milley hristine Jowett is used to taking care of others, but her own health crisis last year turned the tables for the mother of two. Jowett is a cardiology nurse at St. Mary’s General Hospital and even though she was diagnosed with autoimmune hepatitis at 13 years old, she had led an active life, including completing a 60km bike tour in June 2013. All of that changed in an instant when an E. coli infection put her life at risk. For most, the infection would be serious, but for someone with a pre-existing condition it became life-threatening. “I wasn’t too bad before and then I just crashed really quickly,” she says. In less than two weeks Jowett went from working as a nurse at St. Mary's Hospital to being a patient at Toronto General Hospital – hoping a matching donor would be available in time to save her life through a liver transplant. It was dire. Her doctor told her she might not make it a few more days without a transplant. “I was just praying and praying that I would make it through the weekend,” she says. Her prayers were answered when on her daughter’s sixth birthday and just two days after being officially listed – a match was found and Jowett received a second chance at life thanks to the generosity of a donor and his/her family.

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Trillium Gift of Life Network, as the provincial agency responsible for organ and tissue donation, is able to facilitate communication between recipients and donor families through anonymous letters. Christine Jowett, a nurse at St. Mary’s General Hospital underwent a liver transplant. She thinks about this gift every day. “Every day I think if I didn’t have the liver I wouldn’t have been able to celebrate my 40th birthday or celebrate Christmas with my children,” she says. “I really didn’t want my kids to grow up without a mother.” Jowett has taken the opportunity

through Trillium Gift of Life Network (TGLN) to thank her donor’s family. “I wanted them to know something good came out of their decision,” she says. “It was a hard letter to write.” TGLN, as the provincial agency responsible for organ and tissue donation, is able to facilitate communication

between recipients and donor families through anonymous letters. For Jowett, a new liver means she has a new outlook on life. “I appreciate things more and I find I’m not in a hurry anymore,” she says. “I was always rushing before.” The experience also gave her a deeper sense of empathy for her patients. “I got to see a whole new perspective from the other side of the bed,” she says. “I got to see what patients go through being poked and prodded.” She also better understands the importance of approaching families to ask them to consent to their loved one being a donor. As part of her job she sometimes calls TGLN to report potential tissue donors; she now has a better understanding of just how important that call is. Jowett has also become involved with a local volunteer organization that raises awareness about organ and tissue donation and transplantation. She is working to encourage her colleagues and those in the broader community to register their consent to organ and tissue donation, to help save the lives of the 1,500 people in Ontario waiting for an organ transplant. Registration saves lives. You can register at www.beadonor.ca, at any ServiceOntario Centre or through the mail by completing the Gift of Life H consent form. n Danielle Milley is Media Relations Advisor at Trillium Gift of Life Network

“Our newest members at Sunnybrook know that OPSEU is the union for changing times, and we have the experience that gets results for hospital workers.”

Warren (Smokey) Thomas OPSEU President

Representing more hospital lab professionals than any other union in Ontario, OPSEU gets you RESULTS. www.joinopseu.org

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Transforming healthcare in Saskatchewan through Lean

What people are saying

askatchewan is gaining national recognition for its efforts to transform its health care system, with the goal of achieving better health for residents, better care for patients, better teams of health care providers and better value for taxpayer dollars. On February 13, 2014, the Saskatchewan Ministry of Health received an IPAC/ Deloitte Public Sector Leadership Award Gold Medal for Putting Patients First and Transforming Health Care. This prestigious award recognizes organizations that have demonstrated outstanding leadership by taking bold steps to improve Canada through advancements in public policy and management.

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Saskatchewan’s Lean Journey

Saskatchewan started its journey to transform its health system with the 2009 Patient First Review, which led to the concept that the patient comes first and needs to be actively involved in their own care. That principle drives quality, safety and service improvements throughout the system and at the frontlines where service occurs. Saskatchewan is the first province in Canada to begin implementing a continuous improvement process called “Lean” across its entire health care system. Widely used in the manufacturing sector and in some high-performing health facilities, Lean is a philosophy or a mindset – a patient-centred approach – to continuously improve the quality and safety of care and eliminate activities that do not add value. Lean promotes fact-based decisionmaking to identify root causes of process problems and to sustain improvement. This leads to long-term cultural changes, not just short-term fixes.

“This is an incredibly exciting time in health care in Saskatchewan. We are the first province in Canada to begin implementing Lean across the entire provincial health system.” - Health Minister Dustin Duncan In 2012, Saskatchewan’s health system was uniquely positioned to introduce this major, meaningful health care reform, with many supportive partners involved. Health regions, health care professionals and associations, unions, health sector agencies and other partners committed to an aggressive program. To follow through with this commitment, the Ministry of Health engaged consultant John Black and Associates (JBA) to further embed Lean practices provincewide. Now two years into its four-year $39 million contract, the Ministry’s investment reflects the size, scale and complexity of the province’s health care system. www.hospitalnews.com

Patients such as Aalt Leusiuk now have quicker access to care at RQHR’s Mental Health Outpatient Clinic as a result of an improvement project. He’s pictured with Karen Muller, a registered psychiatric nurse. Photo credit: RQHR Medical Media Services JBA is training 880 Saskatchewan health care executives, board members and managers in Lean leadership, which will allow the province to become self-sufficient and no longer reliant on outside expertise. As part of this training, more than 1,000 quality improvement projects will occur across the health system to improve patient experiences and reduce errors. The province’s 43,000 health-care workers are also receiving basic Lean training – focusing on the patient, thinking and acting as one, and acquiring new skills to think about and do their work differently.

Key results

To date, Lean efforts have resulted in a number of quality, efficiency, safety and productivity gains. For example: • Better management of blood products has achieved a 17 per cent reduction in product waste, saving $35 million since 2010 by improving inventory management and reducing inappropriate product use. • Specialist groups around the province are using pooled referrals to reduce patient wait times by as much as half. • Patients brought to Saskatoon’s St. Paul’s Hospital by EMS ambulance are now transitioned to nurse care 67 per cent faster, freeing up ambulance staff’s time for incoming calls. This reduction from 37 minutes to 18 was accomplished through standard work, improved handover processes and more efficient use of space. • Parents in labour now register directly in Labour and Delivery on the fourth floor of Saskatoon’s Royal University Hospital, rather than registering in the Emergency Department. This reduces their walking distance by 85 per cent and removes one stop in their journey to receiving care and becoming parents. • Through the creation of standard work, the Regina Qu’Appelle Health Region’s (RQHR’s) Mental Health Outpatient Clinic virtually eliminated appointment cancellations initiated by the clinic. Previously, 42 per cent of all appointments with psychiatrists were cancelled – 31 per cent

were initiated by the clinic, while the remainder were the result of client cancellations and “no shows.” Major capital projects are also Lean priorities, including the new Children’s Hospital in Saskatoon and Moose Jaw Regional Hospital. Using Lean in facility design will improve processes, reduce waits and improve experiences of patients, families and health care providers. For example, the design and care model of Moose Jaw’s new hospital will allow health care services to come to patients in single rooms, rather than requiring patients to travel throughout the hospital. Using Lean also reduces costs: Moose Jaw’s hospital is expected to save $85 to $160 million over 20 years through operational efficiencies.

True to the province’s Patient First focus, Lean improvement events always include patients. Their ideas and experiences actively shape and inform the event, ultimately improving the health services in a way that matters to patients. According to Kim Camboia, a patient advocate who has participated in a number of Lean improvement events, “I believe in the work that we are doing in the Lean process and I believe in everyone’s ability to pioneer change. It won’t be easy and it won’t even be hard. It will be defeating and at times even hopeless… but so rewarding and so worthwhile.” Not only is Saskatchewan gaining national attention for its health care system transformation, attention is coming from beyond Canada’s borders: “What you are doing in Saskatchewan is globally significant. It is ambitious and creative. The eyes of the world are on you, says Helen Bevan, Chief of Service Transformation, UK’s National Health Service Institute for Innovation and Improvement Bonnie Brossart, CEO of the Saskatchewan Health Quality Council, sees a strong future for renewal in the province’s health care system, “Our commitment in Saskatchewan to think and act as one system, in the name of putting patients first, is the envy of provincial health care systems across the country. In fact, health systems across North America and indeed around the world are watching, as this province works to achieve yet another health care H first.” n To find out more about how Lean is being used to make health care better and safer in Saskatchewan, visit BetterHealthCare.ca

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Nephrology clinic helps slow kidney disease By Priya Ramsingh

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n ounce of prevention is worth a pound of cure. Just ask Dr. David Perkins, Division Head, Nephrology for Trillium Health Partners’ Regional Chronic Kidney Disease Program. The old adage is the philosophy behind the hospital’s new Regional Nephrology Clinic’s mandate to help patients with kidney disease manage their illness better in order to slow its progression and delay the need for treatment such as dialysis. “The Regional Nephrology Clinic is really focused on getting our patients the best possible care at the right time,” says Dr. Perkins. “We know that patients with chronic kidney disease benefit from being seen by a nephrologist early in the onset of their disease. By making it easier for primary care providers and specialists to refer their patients for renal assessment to the clinic, and for patients and their families to receive the care, education, and support they need, we are helping to improve the quality of care and treatment and slow down disease progression.” Launched this past April, the clinic is located on the main floor of the Carlo Fidani Peel Regional Cancer Centre and Ambulatory Care building at Credit Valley Hospital and is staffed with a team of experts. Nurses, nephrologists and clinical educators incorporate best practices in chronic disease management including self management and education. The clinic features a new centralized in-

HOSPITAL NEWS MAY 2014

take model, which is the key to the method of prevention. Using a simple, standardized referral form, primary care providers and specialists now have a single point of contact for their referral, and appointments can be made within days.

For the patient, the convenience of going to one location to meet with health care providers, receive information and pick up medication can make the task of disease management that much easier. In the past, there were challenges ensuring patients with kidney disease had quick access to the most appropriate care. Primary care physicians would refer their patients with kidney disease to a nephrologist. But as with many specialist referrals, securing an appointment could take months. In the meantime, there could be visits to pharmacists for medication to manage the symptoms all while waiting in the community. By the time patients met with nephrologists, the disease may have progressed beyond early stages. ”It can be frustrating for patients who had to make multiple trips from primary

care to pharmacists and then back again. If they missed an appointment it could be weeks or months before they were seen again,” says Sandy Beckett, Manager, Regional Chronic Kidney Disease Program. Once patients are diagnosed by a nephrologist, they meet with a nurse who provides education on managing their disease, and helps them understand options for treatment. This enables patients to make better decisions, sooner. This type of early intervention also brings families into the equation so they will have the information they need to assist with managing the disease at home. For the patient, the convenience of going to one location to meet with health care providers, receive information and pick up medication can make the task of disease management that much easier. “It’s a much more proactive, patientcentered model of care, as opposed to a provider-centric model,” says Beckett. “Now, there is one entry-point.” In addition, once patients enter the clinic’s system they are easily tracked. Not only does this allow for closer monitoring of the patient’s progress, but it enables Trillium Health Partners to compile data for research that can eventually lead to better health care outcomes. The clinic is aligned with the Ontario Renal Network (ORN), the provincial government’s advisor on renal care in Ontario. ORN provides overall leadership and strategic direction to organize and manage

the delivery of dialysis and chronic kidney disease services in Ontario. “At ORN, our mission is to work together with our regional partners, patients and stakeholders to improve the life of every person in Ontario with kidney disease,” says Dr. Peter Blake, ORN provincial medical director. “This new clinic aligns with the Ontario Renal Plan, which lays out strategic priorities aimed at delivering high quality patient-centred care while driving improvements in the renal system. We are extremely pleased to support and help improve care for chronic kidney disease patients in the community.” The establishment of the Regional Nephrology Clinic supports Trillium Health Partners’ strategic priority to provide the right care in the right place at the right time. The clinic’s centralized intake approach will bridge gaps to improve the patient’s journey, deliver better patient outcomes and respond to the most pressing needs of patients with chronic disease. As Ontario’s population continues to grow and age, the prevalence of chronic kidney disease is expected to rise. According to the Kidney Foundation of Canada, approximately, 1 in 10 Canadians has kidney disease, while an estimated 1.5 million Ontarians have or are at increased risk for H developing kidney disease. n Priya Ramsingh is a Senior Communications Advisor at Trillium Health Partners.

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Improving pediatric rehabilitation By Claire Florentin

t Holland Bloorview Kids Rehabilitation Hospital, researchers and clinicians collaborate and share expertise to improve rehabilitation techniques for children and youth using prosthetic devices. Sometimes that means Jan Andrysek, a Scientist in the Bloorview Research Institute, is called in by the clinical team to bring a research lens to a clinical innovation. Jan researches new technologies and techniques to help people with severe physical disabilities walk. Other times, Jan enlists the help of the Prosthetics and Orthotics Department at Holland Bloorview to provide a clinical perspective for his research study. Prosthetists in the clinic build prosthetic devices and provide clinical rehabilitation for their clients.

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WiiFit for rehab: A clinical innovation

The idea to use the WiiFit technology as a clinical tool for kids with recent amputations came from Bryan Steinnagel, a Prosthetist on the clinical team. Bryan saw the WiiFit platform demonstrated at the Electronic Entertainment Expo in the US. “As soon as I saw the WiiFit, I thought ‘That’s what we need!’ I knew it would get kids up and moving.” Bryan and the clinical team thought the WiiFit would be an excellent tool for augmenting physiotherapy for children and youth, who spend most of their therapy time practicing weight shifting on a new prosthetic device. Unfortunately, explains Bryan, “most of that work is traditionally done standing between two parallel bars with a therapist saying ‘Okay, shift your weight to the left, now to the right.’ That can get pretty dull for a kid.” While Bryan and the rest of the clinical team were fairly sure the game, based on a pressure-sensitive pad that detects fullbody movement, could help motivate their young clients, they needed a way to prove

that the WiiFit was a sound clinical tool that would produce verifiable results. That’s where Jan Andrysek came in. Jan helped with the study design, which first involved validating the WiiFit as a reliable clinical tool, and then sending it home with participants along with a schedule of game play. The research study results were compelling – the data showed a small but significant difference in how the clients were shifting their weight, which they attribute to the feedback provided by the WiiFit system, and researchers found that the results of therapy sessions “stuck” better because the kids were practicing their weight shifting movements at home by playing the WiiFit games. Tara-Anne D’souza, a Holland Bloorview client, now 15, was just 10 when she participated in the WiiFit study. TaraAnne was undergoing rehabilitation for a recent amputation. She remembers the WiiFit was fun and a great motivator to do her exercises. Tara-Anne agreed that the WiiFit technology made rehab more enjoyable. “I’ve never been great at handheld video games, but I really enjoyed this. It was very attainable – I just had to get to level six! Hooking it to the game was so much better, because your exercises didn’t feel like work, they felt like fun.” She also said the WiiFit provided additional bodily awareness, which is crucial for someone just one year after an amputation. Tara-Anne doesn’t use the WiiFit anymore; she’s moved on to breaking Canadian records in the Paralympic Swimming (or Paraswimming) Nationals. But she says that the WiiFit was a helpful clinical tool when she was first adjusting to her new prosthetic, and she sees the value in continued use for kids. For Jan’s part, he’s excited that he was able to provide the research support to something that stemmed from clinical need. “It was an excellent concept that required the rigour of research to assure that it could be used in the clinic as an evidence-based tool. To me, that’s the best example of how research and clinical care can work together.”

Albert Phan, a Holland Bloorview client, participated in a research study to assess the value of WiiFit game technology as a therapeutic rehabilitation tool. though, Jan needed a clinical perspective from professionals who fit and train clients with prosthetic devices every day. Shane Glasford, Prosthetic Team Leader, has provided Jan with clinical input over the years. “Research has been picking our brains for a long time on this project, from the development of the original idea, to using the mechanism for the LC knee.” The Prosthetics department also helped with

study recruitment, tapping into their client network. Jan says the support from Shane and his team has been crucial. “I’ve solicited their feedback on various iterations of the design, and I’m glad that I had their perspecH tive at all those points along the way.” n Claire Florentin is a Senior Communications Associate at Holland Bloorview Kids Rehabilitation Hospital.

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Scientist Jan Andrysek says clinical input was crucial to the development of the LC Knee, currently in testing around the world www.hospitalnews.com

Other times, the situation is reversed, and a research innovation requires clinical input. Jan is currently developing the LC Knee, a low-cost, light and sturdy prosthetic knee joint that can offer affordable help to people with amputations worldwide. For the cost of about $100, this injectionmoulded plastic knee joint can withstand rough conditions like water and sand. The LC Knee is currently in testing around the world, and Jan hopes to make it widely available to people for whom a prosthetic device would not otherwise be attainable. In developing and testing the LC Knee,

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12 Focus

SURGICAL PROCEDURES/TRANSPLANTS/ORTHOPEDICS/REHAB

Improving patients’ quality of life with at-home dialysis tients’ day-to-day lives, notes Renal Centre nurse Janice Brown-Martin. Some patients travel an hour to get to the Islington Avenue site, she says, then it takes them half an hour to get connected to the machine – meaning they may spend 5 to 6 hours for a three and a half hour treatment. It can be quite a cumbersome process, and sometimes makes holding down a job impossible. With these concerns in mind, St. Joe’s began the Homeward Bound program in October 2011 to help patients dialyze at home, instead of a clinic.

By Lauren Pelley emodialysis machines look complicated, but Flynn Ramirez has no trouble hooking one up. With the skill that comes from constant repetition, he attaches a fresh pack of saline solution, along with the numerous tubes used to transfer blood through the system – a life-saving process that cleans blood for patients whose kidneys aren’t working well enough to do the job themselves. He adjusts the roughly four-foot-tall machine’s settings and double checks all the bags and tubes to ensure they’ll properly pump blood through the dialyzer. Then, he lifts his shirt up and gets ready to attach the tubes on the machine to the tubes coming out of his chest. Flynn isn’t a nurse or a doctor. He’s a patient, dialyzing in the comfort of his bedroom, thanks to a program dubbed “Homeward Bound” at St. Joseph’s Health Centre. “It’s really easy now,” the 56-year-old Etobicoke resident says of his at-home dialysis, which he started doing back in March 2013. Ramirez dialyzes every other day, and works the 6-hour treatment around his schedule – sometimes dialyzing while he sleeps, other times while friends pop by for a visit. This comfortable routine is a far cry from the overwhelming diagnosis Ramirez first received from his doctor: high blood pressure that had affected his kidneys, leaving both at a 13 per cent functioning level. “My wife and I were devastated… I could not accept it right away,” Ramirez recalls. The diagnosis meant he had to do he-

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If patients are interested in doing dialysis at home, staff at the Renal Centre conduct an in-depth interview to figure out how to make it happen

Patient Flynn Ramirez dialyzing in the comfort of his home. modialysis regularly at St. Joe’s Community Renal Centre, which provides hemodialysis stations and a renal management clinic for patients like Ramirez who are suffering from renal failure. “When renal failure occurs, it means (the kidneys) aren’t performing properly – and so you end up with waste products building up in your blood,” explains Jacqui Cooper, patient care manager for the Renal Therapy program at St. Joe’s.

In hemodialysis, the patient’s blood is pumped through a machine, where it passes through a membrane and is then returned, in a clean state, back into their body. It’s a rescue therapy, according to Cooper. “Patients have to have dialysis if they want to continue living,” she says. “It is that serious.” Serious, but inconvenient. The trek to a clinic for dialysis can take a toll on pa-

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Better care for a better life HOSPITAL NEWS MAY 2014 Bayshore.indd 1

Therapy & Rehab 2013-05-28 10:33 AM

“Being on a home therapy allows them to go back to work and normalizes their life again,” says Cooper. It’s also a better quality of dialysis, she adds, because it can be done for longer periods of time at home, rather than the condensed variation found in a clinic setting due to shared machines and high demand. If patients are interested in doing dialysis at home, staff at the Renal Centre conduct an in-depth interview to figure out how to make it happen, by determining the patient’s knowledge of their disease and their support network at home. Once they’ve been deemed capable of doing athome dialysis, staff start on the training. “On average, it takes patients six weeks to learn (at-home dialysis),” says BrownMartin. Patients aren’t sent home until they can do the entire process without assistance. There is also on-call support 24 hours a day, seven days a week, and a built-in alarm system on the machine that goes off if there is even a drop of blood spilled. Ramirez takes comfort in the at-home dialysis system he’s now mastered. His wife has gotten used to the machine, he says, and he only needs to check in with his doctor once every two months. “If there are no problems, you just relax at home,” he says with a laugh. Yet many patients still choose the clinic route, rather than dialysis at home, despite what Ramirez and St. Joe’s staff see as obvious benefits. “I just wish more patients would actually consider it as an option,” says BrownMartin. “A lot of people are scared.” Ramirez was one of those scared patients – at first. But dialyzing at home “is really a lot easier,” he says, crediting St. Joe’s team with making it happen. Now, he can stay healthy without constantly trekking out to a clinic. “Thanks to them – to the doctor, to the H nurses, to this facility – I’m okay.” n Lauren Pelley is a Junior Associate in the communications department at St. Joseph’s Health Centre Toronto. www.hospitalnews.com


special pull out section

National Nursing Week

May 12–18, 2014

commitment | dedication | excellence | compassion


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ARAMARK SALUTES NATIONAL NURSING WEEK Aramark is proud to sponsor the Hospital News’ National Nursing Week contest to recognize nursing heroes. Aramark works in collaboration with nurses in our client hospitals and residences across Canada.

Partners in Outstanding Care Delivery

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HOSPITAL NEWS MAY 2014

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Congratulations to the winners of our

All nurses are

heroes ome heroes wear capes and have superhuman powers; others wear insignia-emblazoned leotards and fight against injustice. The heroes we salute in the upcoming pages do not have superhuman powers – and are usually attired in scrubs – but they are a breed of hero unlike any other. As you browse through the pages of this supplement celebrating nurses, you will see that this year’s Nursing Heroes Contest was a tremendous success. In fact, we received a record-breaking 120 nominations for 107 nurses – nearly triple the number received when this contest debuted nine years ago. Every year I am amazed by the calibre of nominations we receive. An off-duty nurse sees a woman in distress pulled over at the side of the road and stops to help, performing life-saving CPR on her toddler as traffic whizzes by. Another nurse notices a patient in his ICU rapidly deteriorating. The nurse arranges for the patient’s wife – who is also in hospital recovering from surgery – to be wheeled into her husband’s room so she can be by his side, in his final moments. An elderly patient in hosThis year we pital with no family is being taking advantage of financially by a neighbour, received a notices and steps in to protect record-breaking ahernurse patient from further abuse. 120 nominations These are all acts of heroism; none for 107 nursing is greater than another. Every nurse is a hero. heroes Nurses are the backbone of the health care system. They do for healthcare what gasoline does for an automobile – they power it and make it work. Without nurses, our system wouldn’t function. The Nursing Hero Contest highlights some of the many heroic acts nurses perform every day, and gives us a chance to say thank you. So often in a busy health care environment people don’t get the chance to express their gratitude. The following pages provide an opportunity to do just that, and show nurses exactly how much they impact the lives of their patients and colleagues. Congratulations to this year’s winners and nominees. This year it was tremendously difficult to narrow down the nominations and select only a few as “winners.” In reality, every single name on the list of nominees is a winner, because they have made a positive difference to someone. With so many nominations, it is impossible to print them all. If you are on the list and would like to read your nomination, I am happy to forward it to you. You can email me at editor@ hospitalnews.com. To all nurses, thank you for everything you do. Hospital News saH lutes you. n Kristie Jones, Editor

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2014 Nursing Hero Awards 1

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Linda Jurincic

Odette Cancer Centre, Sunnybrook Health Sciences Centre

$1000

Cash Prize

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Heather Chinnery

Stollery Children’s Hospital, Alberta Health Services

$500

Cash Prize

3

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Madge Reece

Humber River Hospital

$300

Cash Prize

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NURSING: A LEADING FORCE FOR CHANGE At Sunnybrook, over 2,900 nurses provide the highest quality of care to improve the health and well-being of patients and their families, when it matters most.

Our nurses work collaboratively within interprofessional teams to provide care when it matters most. Our nurses are committed to continually learn and lead initiatives using a person centred approach.

NURSING WEEK - MAY 12 TO 18

We are very proud and thankful of the unique contributions of our nurses at Sunnybrook. They are passionate about the care they provide.

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OUR NURSES Knowledge professionals providing inspired care We believe that our nurses are a true expression of our mission and values who place compassion, respect, social responsibility and excellence at the forefront of patient care.

We recognize our nurses’ professional knowledge, experience and tireless efforts in

Today, and every day, we thank our 1,800 nurses for their unwavering commitment to our culture of caring and innovation.

fulfilling our legacy of quality care and discovery.

We value the contribution our nurses make – working around the clock, changing lives everyday. We celebrate our nurses’ many accomplishments and their dedication to nursing excellence in patient care, education and research. HOSPITAL NEWS MAY 2014

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Linda Jurincic

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Odette Cancer Centre, Sunnybrook Health Sciences Centre

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am nominating Ms. Linda Jurincic at the Odette Cancer Centre at Sunnybrook Hospital for the Hospital News 9th Annual Hero Award. It is impossible to summarize in a few words what kind of nurse Linda Jurincic is. Linda is thoughtful, kind, she has a wonderful sense of humor that can lighten any situation. She takes the time to do the little things that mean so much. Linda has a special gift of providing comfort and support when needed. Linda demonstrates the “heart of nursing.” There are so many examples that I can use to describe why Linda is an amazing nurse. In the past few years I have been through so much. A DVT in my right leg, learning how to inject lovenox into my abdomen cone biopsy with extensive hemorrhaging, an operation for a hysterectomy that didn’t happen because of the extent of the cancer in my pelvis and paraaorta area, chemo and 4 months of radiation 5 days a week. My first HDR treatment is where I met Linda. I have to say I was pretty scared because of my previous hemorrhaging and my blood clot. The thought of having to be put under for my HDR did not sit well with me. I was scared that the blood clot would move and I would die. Linda was at every one of my HDR appointments. She was kind and very upbeat. She would insert my intravenous needle into my small veins. Inject me with my lovenox. Linda ordered lovenox in the milligrams I needed so I would not have to use my supply because of the expense. She also taught me how to inject my lovenox correctly so it wouldn’t sting and to stop me from getting huge bumps and bruises. Linda helped calm me, keeping things light by talking, joking and making me feel comfortable. She also sang You Are My Sunshine as we walked into the operating room and she continued until I fell asleep. When I awoke Linda would have ginger ale and a cookie from her own lunch for me. About half way through my HDR treatments I decided that I would not finish them because of the bleeding and I was sick of being tired and run down. Linda told me to come in, sit with her and if I didn’t want to finish I didn’t have to. Well Linda ended up talking me into finishing my

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treatments. She was right I needed to finish so I had no regrets later on. After that HDR treatment Linda told me they fixed my bleeding problem. I am so grateful to Linda, for talking some sense into me so I would finish my treatments. In June 2013, I had a CT Scan and MRI both suggesting my cancer was not gone and maybe the cancer had spread to my bone. A PET Scan was urgently ordered. I was a wreck and Linda helped me through a very difficult time. The day I got the results from the PET Scan results, my family, my doctor and Linda were there holding my hand. I got the amazing news that I am cancer free. Linda leaned over and whispered in my ear and said “I told you that everything would be fine.” I see Linda every three months for my follow up appointments. I am greeted with the biggest smile and hug. I squeeze her hand or arm because I hate my internals. She also looks after my wellbeing. I have been depressed and she talked to me about my issues and made me realize that I must enjoy life and she made an appointment for me to talk to someone. My definition of a nurse: Go above and beyond the call of duty. The first to work

and the last to leave. The heart and soul of caring. A unique soul who will pass through your life for a minute, but impact it for an eternity. This is Linda. Nominated by: Kimberly Fulcher

2ND NOMINATION

accolades but because it is the right thing to do, someone who is a role model and makes a difference in another’s life. Ms. Linda Jurincic truly exemplifies what a ‘Nursing Hero’ is. I have had the pleasure of working with Linda for last 8 years at the Odette Cancer Centre. During this time, I have seen firsthand, the positive impact she has on her patients. She goes the extra mile for each and every one of them, whether it is holding their hand during a procedure, or listening to their fears and concerns and addressing each one until they are comfortable, or empowering patients to be active members of their health care team. The patients that she touches love her which is evidenced by their inquiries when she is not around. Linda provides holistic person-centered care rather than a disease-approach to care. One such moment occurred recently, when a patient came for her first internal radiation treatment. The patient was extremely nervous. Linda listened to her fears, held her hand, wiped away her tears, and provided the information and education the patient needed to get through the treatment. However, it was during the conversation that the patient expressed what was really bothering her. The patient had recently lost her job and was dealing with this in addition to her cancer diagnosis. Linda acknowledged her loss and her fears but also provided great suggestions and support to help her get back on her professional feet. The patient was so appreciative that Linda took the time to listen to her. Linda is generous of her time, generous of her vast knowledge and generous of her skills to ensure that every patient she encounters receives the highest quality of care. I have recently been appointed to an advanced practice position in radiation therapy. Linda has been a source of support, guidance and mentorship, teaching me new skills and increasing my knowledge base in gynecological cancer treatments. Linda has been a truly inspirational nurse to not only her patients but also for all health care professionals across the entire oncology program. Her passion and dedication to providing the best patient centered care has improved the care we deliver. Her commitment to her own professional development and continuous learning provides me with a positive role model to look up to. For these reasons, I believe Linda is truly deserving of this presH tigious nursing award. n Nominated by: Laura D’Alimonte

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It is my great pleasure to provide this letter of recommendation for Ms. Linda Jurincic for the annual Nursing Hero Award. Linda was my primary nurse from 2007 to 2012 and became part of the nursing team that cares for my patient population in 2012. Linda is a senior nurse with many years of clinical experience. She started with the cancer program in 2007 after an injury precluded continued work in the ED. She tackled the new content area with the enthusiasm and curiosity of a young learner. She continues to ask questions of me and other physicians about the care we provide in order to improve her understanding and enable her to provide better care for her patients. She is a very astute clinician. In 2013, she sought and obtained her oncology nursing credentials. Her continued dedication to lifelong learning is inspiring. Linda is extremely devoted to the patients she cares for and forges strong relationships with many. She calls them "her people." I have known her to call patients well after they have finished treatment and are in the follow-up phase of care to see how they are doing and for example, "get that cannelloni recipe." I have known her to personally follow up lab results to call patients on the weekend (e.g. a urine C+S). It is not uncommon for me to enter a patient room and have the patient greet me politely, only to be followed by Linda and hear an exuberant "HI LINDA!" Being able to connect with her in person is clearly the highlight of their visit. She is a huge source of encouragement to her patients. Linda inspires me to maintain and improve the humanity in my medical practice. Nominated by: Dr. Lisa Barbera

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What constitutes a hero? For me, a hero is someone who does something without thinking of themselves, someone who jumps at the opportunity to help others without question, not for the rewards or

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Supporting the nursing profession.

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Heather Chinnery Clinical Nurse Specialist

Neonatal Intensive Care Unit, Stollery Children’s Hospital s a nursing expert in the NICU, Clinical Nurse Specialist Heather Chinnery led the implementation of delayed cord clamping (DCC) in pre-term babies, making the Neonatal Intensive Care Unit (NICU) at the Stollery Children’s Hospital's Royal Alexandra Hospital (RAH) site in Edmonton the first facility in Canada to make this a standard of practice. A neonatologist at the Stollery approached Heather with European studies showing that delayed cord clamping significantly reduced the risks of brain injury and hospital-acquired infections, and reduced the need for blood pressure support in babies born between 22 and 36 weeks of gestational age. At that time, the practice for pre-term babies in Edmonton was to immediately clamp the umbilical cord and move the newborn to a neonatal warmer. Heather lead an interprofessional team charged with implementing the practice change, developing indications and contraindications, and with measuring both staff adherence and patient outcomes. This change in policy and procedure not only crossed departments (NICU and Obstetrics), but hospitals and required education and training of large numbers of staff and physicians. As the first site in Canada to initiate this practice, intake of new learners (staff and physicians) required on-going education to help staff adopt the new practice. As with major practice changes, uptake of the new protocol was slow and inconsistent, requiring close monitoring and frequent follow up and re-education. Now, the team delays clamping the umbilical cord by 60 seconds, allowing the baby to take his first breaths and receive blood from the placenta. This extra blood stabilizes the baby’s blood pressure and is also thought to boost stem cells, which help fight infection and repair damaged cells. Since this standard of practice was introduced at the Stollery's RAH NICU Children's Hospital in 2008, there is documented evidence of improved health and outcomes for pre-term babies in the NICU. The rate of necrotizing enterocolitis – a condition where tissue in the bowel starts to die – has been reduced from 5.4 per cent to 1.5 per cent. As well, the proportion of pre-term babies whose core temperature drops below normal levels has been reduced from 31 per cent to less than 20 per cent. Over the past four years, the labour and delivery unit at the Lois Hole Women's www.hospitalnews.com

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Hospital in the RAH has used delayed cord clamping on all pre-term babies not requiring other immediate interventions. There are about 50,000 births in Alberta annually and, of those, about 6,500 (or 13 per cent) are premature – the highest rate of pre-term births of any Canadian province. The national pre-term rate is about 10 per cent. Nationally, delayed cord clamping is used on less than 10 per cent of all pre-term babies. The DCC practice was expanded throughout Edmonton hospitals in 2011, and is now being shared with facilities across the province and the country, thanks in large part to Heather’s knowledge, expertise and passion. I have had many opportunities to experience Heather Chinnery’s dedication to the patients and families who are recipients of her expert knowledge and exceptional care, as well as that of her colleagues and the neonatal community extending beyond the walls of the hospital. Her involvement, hard work, and dedication to implementing a practice that has improved outcomes for pre-term babies is very close to my heart. As a parent of very premature and critically ill twins, I have fond memories of Heather and the help that she gave us when the boys were in the hospital. One instance I remember quite clearly: After Andrew’s surgery, his stomach had a large incision and needed to heal. The regular bandages and treatments weren’t quite working for him. As the Wound Specialist, Heather came up with a new system which included a funky patch that Andrew had on his stomach. In order for this patch to work, it had to be left on and not removed like regular dressings. Heather made sure that the patch wouldn’t be removed by writing with a Sharpie pen directly on the patch “Do Not Remove” across the patch on his tummy. It proved to be very successful. I always felt that Heather had Andrew and our best interests in mind, and she tried her very best to help Andrew. She was always kind, caring and compassionate. I have also drawn on her expertise as I work to complete my degree in Health Administration and facilitate my own learning. As part of my term paper for a Risk Management and Quality Improvement course, I was asked to review a relatively unknown clinical practice that, if widely implemented, would improve the quality and outcomes for patients. Heather’s work on Delayed Cord Clamping was inspiring and fit the criteria perfectly. Heather took

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the time to share her research with me and helped provide me with an understanding of the work involved. I wouldn’t have gotten the A+ without her! As a colleague, I have had the pleasure of working directly with Heather and her team on various projects focused on ensuring family centred care in the NICU. Whether it be educating new staff, introducing new practices or being part of the setup of new programs (such as introducing a focused approach to developmental care in the NICU), she consistently demonstrates her commitment to the patients, their families and her colleagues. She shows creativity in finding solutions.

Solutions based on facts. For example, to test the effects that ambient noise in NICU had on babies, she engaged the audiology department to test the sound levels in various conditions. These included with the incubator top up or lowered, an incubator with or without a cover, what was with the baby in the incubator (e.g. blanket, etc.), conversation levels and noises during procedures. This thorough approach helped determine the best possible environment for these most fragile of babies. There are many such examples where Heather’s innovative approach improves the experiH ence for babies and their families. n Nominated by: Marni Panas

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Madge Reece Mental Health Unit, Humber River Hospital

adge Reece received six nominations for the Nursing Hero Award. Every single nomination came from a patient or a patient’s family member and everyone said the same thing. Madge went above and beyond as their nurse. Here are a few of the nominations:

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NOMINATION 1

I had met nurse Madge at a time when I was going through a rough patch with my health in January 2014. I had been admitted into the hospital. I remember being so scared to be there. However, she had a calm nature that was reassuring to me. My stay at the hospital lasted over two weeks. Madge made sure that I was cared

We thank our nurses for providing quality care and service As we celebrate 2014 National Nursing Week and its theme “Nursing: A Leading Force for Change”, we’d like to thank our dedicated team of nurses for the quality care they provide to our patients at Rouge Valley. Each day our nurses deliver quality care to our diverse patient population. We value their expertise, skills, and abilities applied to a variety of clinical areas. Our Clinical Practice Leaders, Managers, Directors, and Vice Presidents promote best practices, improve processes and systems, and shape health policies. As frontline staff, our Registered Nurses, Registered Practical Nurses and Nurse Practitioners provide direct patient care and impact the lives of our patients in many ways: • Providing critical and emergency care as part of our Regional Cardiac Care program, or in the Emergency department, and Critical Care units • Helping to bring new lives into the world in our Women’s and Children’s Health program • Providing acute and restorative care with patients in Medicine and PostAcute Care • Supporting patients and families in coping with the challenges they may be facing in the Mental Health program • Holding the hand of a nervous patient while preparing for surgery We thank and commend our nurses for the care and compassion they show to their patients, families and colleagues. Thank you for making a wonderful and profound difference at Rouge Valley Health System. Rouge Valley Health System www.rougevalley.ca

HOSPITAL NEWS MAY 2014

for and that I was doing the basic necessities to get myself well. She encouraged me to talk to others, eat my food, cancel my health appointments that I couldn’t attend and always made sure I was alright. Her positive attitude gave me hope. I had no visitors during my stay at Humber River Hospital. Madge had kind words that showed me compassion. When I started to show signs of health improvement, I could tell that Madge was sincerely happy for me. She had said things to me that uplifted my spirits. I noticed that on the floor her patients were getting the best care possible. She was thorough with her treatments. As a team leader, she had shown leadership with staff and patients. I am very grateful to have received the best care from Nurse Madge. Nominated by: Marigrace Galura

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I met Nurse Madge Reece in August 2013, when she came into my room 425 to do my stats. Right off the bat I felt at ease with her. After taking my stats she sat with me for a few minutes to get an assessment of my mental well-being. She was very sympathetic as well as empathetic with my condition. God must have sent her to be my guardian angel that morning (teary moment) because she was the first nurse I saw besides those that admitted me throughout the night. I felt comforted by her, in speaking with her I felt like my mom was there in sprit but not in body. We sat for thirty minutes talking, with her giving me inspirational quotes to live by. I felt the weight lifted off my shoulders after speaking with her. I developed a bond with Madge that will not be broken until death do us part. She is now my adopted mother. Throughout my stay on the unit, I constantly sought her out just to bask in her glory. I felt I needed to feed off her spirituality in order to continue my recovery. I was right, it has helped immensely. I still felt the same way on my second visit to the hospital. I like how she treats people with the respect and inherent dignity they deserve. She’s approachable in her manner and her

presence. These qualities are hard to find in many others and so for me she is divine. I also like the fact that she does not try to impose her judgment on others but allows each individual to find ways that are favorable to them in solving their problems. I felt Madge went beyond the call of duty in her care for me during my stay. My family adores her; my friend Davilyn felt that Madge is an inspiration to others and that she has a huge heart. The fact that Madge took us under her wings and helped to instill in us values that we never had is one of the reason my family friends are so drawn to her. I am very thankful that I met this lady when I did because she has somehow changed the course of my life. Madge not only inspired me but encouraged me and my family as well. She has opened their understanding to dealing with mental health issues, something that was previously not discussed in our close knit family. She shows my family and friends the compassion required to deal with the touchy subject matter of what goes on in a patient with mental health and for that I am eternally grateful. I would like to nominate this lovely lady to be a Nursing Hero because she embodies Grace, Beauty, Soul, Heart and a love for nursing like no other. Madge is the Mother Theresa of nursing. Nominated by: Marsha Taylor

NOMINATION 3

I was a patient at Humber River Hospital in February 2014. I thought all was lost in the world and needed to end my life. I felt ashamed, lost, and alone. After my second day at the hospital, I met the most compassionate and caring nurse, Madge. She helped me believe in myself, my family love, and gave me hope to have the will to live. She put a smile back on my face, when I thought all was lost. Madge is my hero and gave me my second chance at life. I thank her for guiding me to the right path of recovery. Madge, you are a blessing to all your H patients and me. n Nominated by: Charmaine www.hospitalnews.com


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Edsel Mutia RN

Charge Nurse Critical Care, North York General Hospital

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n his role as a Charge Nurse in Critical Care at North York General Hospital, Edsel provides admirable leadership skills to guide new staff and colleagues for a 24 bed unit hosting critically ill patients. More importantly, Edsel is well-known for being a seasoned professional and an advocate for needed changes in the critical care department as well as has mentored many new nurses and nursing students. He is described as warm and compassionate with a sound knowledge of nursing practices. Edsels’ career includes nursing positions at various hospitals both nationally and internationally, obtaining extensive experience in coronary and intensive care. Among colleagues, Edsel is known as one who speaks with knowledge and strives to improve the health and wellness of the people whose lives he touches. This desire for lifelong learning has effectively increased his ability to provide compassionate, client-centered care in a variety of settings. Edsel is recognized by his colleagues as being passionate about his care and professional development, never satisfied with the status quo and always looking for opportunities for improvement. One example that illustrates this involved a 32-year old patient with a recent

diagnosis of ALS. Edsel worked closely with the patient, connecting him with supports within the community for post discharge, providing emotional support and positive reinforcement along with culturally sensitive care to the family members involved. This patient was discharged in better spirits having hope for his condition knowing that there were support systems available to help him cope effectively. Edsel was easily able to develop a supportive and culturally sensitive reBLE HONOURA N lationship with this young IO MENT ate interventions and support to patient whom many others be provided. He spent time with stayed away from due to the this patient and got him a motoremotionally draining situation ized wheelchair, allowed the child to they found themselves in and they listen to music and read the news. Taking found it challenging to deal with the family. Edsel, in a very natural and respectful the time to provide psychosocial support in manner was able to intervene and advo- this child’s life when his own parents were unable to effectively do so demonstrates cate for this patient and his family. He is that Edsel goes above and beyond to care well known for effectively managing and for his patients. When this patient was caring for our most challenging patients. transferred to a chronic care unit, Edsel A second example involves a 17-year old boy who was admitted from home with continued to visit him and provide supMuscular Dystrophy, whose mother had port. Edsel is very humble about his skills. abandoned him and his father evidently He personally mentored me when I was a was experiencing caregiver burden. Edsel new graduate and the thing I most respect frequently advocated for this young cogabout Edsel is his ability to teach and mennitively aware patient for age appropri-

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tor others. He has the serenity, patience and experience to bring new nurses along in their practice, giving them the confidence they need to succeed. Working the nightshift for many years with minimal management, he has become an expert leader, being able to make critical decisions daily with very little resources at his fingertips. He is also well respected by his colleagues, patients and families. Edsel has never lost his sense of empathy and caring in the many years of nursing he has provided care. It would be an honour to recognize someone of his calibre for his excellence in achievement of professional H development. n Nominated by: Sharon Fernandes

THANK YOU ROUGE VALLEY NURSES!

Our Board of Directors, staff, physicians and volunteers at Rouge Valley Health System wish our nurses all the best for National Nursing Week 2014. Thank you for helping us to live our vision to be the best at what we do for patients.

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Qunyu Li

Cardiac Function Clinic, Mackenzie Health unyu is an exceptional Nurse Practitioner. She arrived at Mackenzie Health in November 2013 and in a few short months has established herself as a kind, caring and compassionate nurse who is passionate about providing care to patients with heart failure. After working at the University Health Network for several years, Qunyu made a conscious choice to move closer to home and begin giving back to her community in Richmond Hill and the broader southwest York Region that is served by Mackenzie Health. She was hired as the first NP in Cardiology in the 50 year history of the hospital. Qunyu was selected as an exceptional candidate for the role based on her extensive experience, knowledge and skill for a very specialized patient population. Her quiet and soft spoken demeanor, in concert with her incredible ability to give voice to the patient experience and drive quality patient outcomes make her a dynamic professional. Qunyu works collaboratively with all members of the health care team in a respectful and professional manner. She has quickly established credibility with her

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physician partners who now seek her out to collaboratively care for patients who benefit from a nurse practitioner who brings a unique approach to patients dealing with heart failure. Through her leadership and visionary thinking and collaboration with an interprofessional team, a Heart BLE HONOURA N Function Clinic was created IO MENT ing guidance, teaching and supand opened in February 2014. port from her as she is a role Qunyu cares for the most model for practice. She creates a complex heart failure patients in safe place for patients and staff to ask the inpatient cardiology unit who often have multiple visits and/or admis- questions and seek clarification about the plan of care. sions to hospital. Through her expert and As a physician partner, Qunyu is an asset compassionate care, Qunyu has been able to the team. She collaborates and consults to provide care that is empathetic, sensitive and focused on the physical as well as appropriate and her judgment is spot on. She brings evidence-based practice to the as emotional needs of the patient. She acinterventions she proposes to patient care tively uses a variety of teaching methods and is introducing physicians to a new way to translate complicated heart health inof interacting with nurses around patient formation into simple terms that are easily care. We strongly believe that through Quunderstood by patients and families. Qunyu values the contributions of in- nyu’s presence and outstanding practice, terprofessional team members and actively we are establishing a new model of service delivery that will make a profound impact involves family in supporting the patient on patient outcomes and satisfaction. This as they transition back into the commuis evidenced by the fact that since her arnity. Her leadership has been felt on the rival and co-implementing a NP collaboraunit where nurses feel supported in seek-

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tive practice model with Mackenzie Health Cardiologists, heart failure patients under that model have had zero per cent readmission 30 days post-discharge where the national average sits around nine per cent. We are so proud and privileged to have Qunyu as part of our team at Mackenzie Health. She brings enthusiasm, energy, and commitment to patient care that is inspiring. Patients and families have responded positively to her approach and are confident that they are being cared for in the best way possible. We believe Qunyu Li is an extraordinary nurse who is worthy of H the Nursing Hero Award. n Nominated by: Dr. Victoria Chan, Clinical Chief of Medicine; Dr. Grace Chua, Clinical Division Head, Cardiology; Tiziana Rivera, Chief Nursing Executive and Chief Practice Officer – Mackenzie Health.

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Lois Robinson RN

Emergency department, Rouge Valley Health System n behalf of all staff of the positive attitude no matter what. AunRouge Valley Health System tie Lois demonstrated the organization’s – Centenary ER, I would like Start with Heart principles before they to nominate Lois Robinson for even were invented. To watch her with this year’s Nursing Hero Award. a small child or even an elderly patient Lois has been at Centenary for 39 years. you can see how easily she can calm It is hard to imagine that this spring Lois their fears with her words or even a simwill be retiring and leaving her emergency ple touch. room family. Auntie Lois is a great mentor when it Looking at the nomination criteria comes to new nurses and to those of us for this award, I cannot imagine who have been here a long, long any nurse in our organization time. She is a true leader who not except Lois who meets each only shows everyone respect but E one above and beyond. It is has our respect as well. Nursing L B A R U HONO difficult to give examples of students and new grads’ fears MENTION how she meets these criteria are often allteviated when workwithout writing a novel so I will ing with Lois as she puts them at provide a brief summary. ease through her professionalism “Auntie Lois” as she is affectionand acceptance of all. ately called by all is the most compassionAuntie Lois demonstrates courage, inate and caring person we have met. She is tegrity and strength of character through often seen giving her “hugs” to staff and her daily practice in the way that she has patients when truly needed. At times of overcome her own personal challenges stress both patients and nursing staff can and provides quality patient care. She always count on Lois for her support. maintains her professional development Auntie Lois has a quiet and calm- requirements so she can continue to proing effect on everyone. She maintains a vide safe and current practices.

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Auntie Lois has a great relationship with her colleagues here at RVC Emerg. This includes not only the nurses but doctors, auxiliary staff, support staff and the entire multidisciplinary team. She truly has our trust, respect and admiration and we can only hope to be as great a person as she is. As mentioned earlier, Lois will be retir-

ing in April. Although we are excited for her, we are also going to miss her terribly. We think that it would be a great way to show how much she has touched our lives and her patient’s lives by presenting her H with this award. n Nominated by Lynn Yantha and the emergency department staff

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List of Nominees 2014 Nursing Hero Awards Heather Anderson Alberta Health Services Lac La Biche Mental Health Kathrine Anderson Thunder Bay Regional Health Sciences Centre Ervin Ang Haro Park Centre, Vancouver Sarah Baird Peterborough Regional Health Centre Monica Ball Orillia Soldiers’ Memorial Hospital Dell Bascus University Health Network Jared Baxter Orillia Soldiers’ Memorial Hospital Kris Bayley Uxbridge Cottage Hospital Paulina Bleah University Health Network Tami Brant Sunnybrook Veterans Centre Susan Breckenridge Almonte General Hospital Elizabeth Brown Hotel Dieu Hospital Marcia Bryant Hotel Dieu Hospital Cheryl Byrns (2) Humber River Hospital Lindsay Carlsson University Health Network Princess Margaret Hospital Cara Carney Runnymede Healthcare Centre Dolores (Lolly) Castro (2) Runnymede Healthcare Centre Sylvie Charette Bruyère Continuing Care, St. Vincent Hospital Heather Chinnery Stollery Children’s Hospital, Alberta Christine Choate Peterborough Regional Health Centre Delia Ciano Mackenzie Health Linda Clark Peterborough Regional Health Centre

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Hospital News salutes all nominees Colette Parker, – McKenny Creek Hospice Residence BC

Colette has been a nurse for over 44 years and is currently working at McKenney Creek Hospice in Maple Ridge, BC. I have been a volunteer at the Hospice for 2 years and I have had the honour of watching Colette be a hero to countless people and families. Her care and compassion far exceeds the daily requirement of doing her job well. We have an altar where the names of people who passed are written and there is a book where families can write something if they choose to. I have seen and heard Colette's name come up again and again for being the greatest of support during such a difficult time. She truly cares about each and every person she takes care of in the Hospice. Losing someone you love is one of the hardest things to deal with so those that have had the support of such a wonderful nurse have been truly blessed.

Kris Bayley – Uxbridge Cottage Hospital

Kris embodies all the qualities of a professional and caring nurse that we all aspire to reach. We work in a small rural ER dept. One night we received a call – teenage VSA. We had about 2 minutes to get ready for this patient. He had been in a terrible car accident not far from our ER doors. Our small ER team worked on him for over an hour using every resource available to us including a couple of ORNGE paramedics that were there to transport yet another acute patient. It wasn’t until well into this code when I was given his wallet to ID him that I found his next of kin was listed as one of our staff members, someone well known to us all. When the deceased patient’s mother arrived, Kris was incredible. This is where you see what the true meaning of being a nurse really is. She demonstrated the perfect combination of caring, compassion and support during this unthinkable time. I was in complete awe of her empathy and professionalism in what was also a very distressful time for her as well. Despite the emotional upheaval of the deceased young man, we still had a full department of patients and no break in sight on our 12 hour night shift. Kris continued the shift providing the care each individual patient deserved. Kris obviously has found her

calling because she is one of those special people that see more than just the patient. When you work in a small community, often you are working with limited resources and frequently on patients that you know. They are your family, friends and coworkers. It takes a very special nurse to thrive under these extenuating circumstances and Kris is one of those rare nurses.

Pernille Pedersen – Princess Margaret Hospital

Pernille is an extremely dedicated and reliable nurse. Stays after hours to take care of patients and sort urgent problems. Always attentive, kind and polite. Has excellent clinical skills and will never “turf” solvable problems. I vote for her with my hands and feet.

Monica Ball – Orillia Soldiers’ Memorial Hospital

Monica goes out of her way to get to know patients and their families, and provides them with clarification of information related to their medical conditions. She welcomes telephone inquiries at any time, and provides answers quickly and efficiently. No interruption is ever a bother to her, no matter how busy her day. She is readily accessible and approachable to GDH patients, whether via telephone or drop-in visits. Monica’s pleasant, friendly, down to earth manner successfully alleviates the anxieties of patients and their family members. She ensures that each concern presented is treated with respect and humanity. She also successfully pre-empts problems; she has often provided families with knowledge and guidance which has resulted in avoidance of crises, emergency department visits or hospitalizations.

Alfredo Cootauco – Runnymede Healthcare Centre

Alfredo is a nurse with a big heart. He understands not only the patient but the patient’s family as well. He never rushes when taking care of my dad. Everything he does is methodical and well-thought out. He is the one who helped my dad during an attempt at toilet training. Alfredo showed respect for my father’s dignity and the situation went well. My dad feels comfortable and at ease with Alfredo as his nurse which means the world to me and my family.

Lauren Hull – North Bay Regional Health Centre

Lauren demonstrates commitment, dedication, compassion and leadership, whether it comes to her patients, colleagues or the public, and she has done this despite the use of only one functioning lung! Identified as “Mother” by staff, she embodies that role in the care that she provides in all her work. She has been a driving force for the Healthy Living Program, which combines the benefits of physical and mental health, through a collaboration of nursing skills with those of a recreation therapist as well as a dietician and general practitioner to epitomize client-centred care. Beyond this, Laurie possesses a wealth of knowledge on Clozapine, which is why nurses and doctors alike approach her for clinical consultation. She also reaches out to external partners to acquire additional resources, which are especially necessary in a healthcare context of increasingly limited funding. Additionally, she participates on a number of projects for the benefit of patients and staff alike, including the Diabetic Education and Support Committee, Health and Safety Committee, while serving as the Ontario Nurses’ Association representative for the Mental Health Clinic.

Ray Lam – The Hospital for Sick Children

As a graduate student in the MSc Global Health program at McMaster University, students were presented with an opportunity to complete an internship in an area of their choice. I had always been passionate about infectious diseases but being new to Toronto I was feeling a bit lost as to where to turn to gain experience. I came across Ray's name when searching for connections and after a few phone conversations he agreed to take me on as his intern for the summer. Ray went above and beyond making me feel a part of his team and a part of my new city. He never treated me as a student but rather would introduce me as a colleague. He constantly challenged me to think outside of the box, push beyond my limits and leap out of my comfort zone. He went above and beyond putting me in touch with several people in an effort to expand my network, offered me hours Deb Hanna-Bull Peterborough Regional Health Centre

Nafeesa Fatima Markham Stouffville Hospital

Whitney Gowanlock Orillia Soldiers’ Memorial Hospital

Cherise Fernando Haro Park Centre, Vancouver

Leona Graham Trillium Health Partners

Kelly Freeman St. Mary’s General Hospital

Sheila Halloway Almonte General Hospital

Joseph Gajasan University Health Network, Toronto General

Kathy Hardill 360 Degrees VON Clinic Peterborough

Margeret (Maggie) Gallagher Orillia Soldiers’ Memorial Hospital

Marvia Harvey Trillium Health Partners

Julie Joseph Runnymede Healthcare Centre

Anne Garland Sunnybrook Health Sciences Centre

Tammy Hirkala Almonte General Hospital

Camelia Jurchescu Runnymede Healthcare Centre

Carla Erum Runnymede Healthcare Centre

Nicole Glaubitz Alberta Health Services, Lac La Biche Mental Health

Arden Hamilton North Bay Regional Health Centre

Linda Jurincic (3) Sunnybrook Health Sciences Centre

Aimee Esmejarda Runnymede Healthcare Centre

Sandra Gosine Trillium Health Partners

Susan Hamilton Saint Elizabeth Health Care

Jeanette Kennel St. Mary’s General Hospital

Angie Coluccio Trillium Health Partners Alfredo Cootauco (2) Runnymede Healthcare Centre Veleta Douglas University Health Network Toronto Rehab Angela Dwyer North Bay Regional Health Centre Helen Dwyer Trillium Health Partners Lauren Edwards Trillium Health Partners

HOSPITAL NEWS MAY 2014

Janice Holmes Trillium Health Partners Lauren Hull North Bay Regional Health Centre Janice Jones Sunnybrook Health Sciences Centre

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of the 2014 Nursing Hero Awards of insight on my scholarly paper, and offered me amazing opportunities to get involved with projects I could have only dreamed to be involved with. It is not too often you enter into an organization as an intern and have a chance to work WITH and be a part of such a cutting edge and well respected team. Ray has brought the infectious disease team together in ways I have never seen before. The usual hierarchy of health care workers is simply not there. Ray has put everyone on an equal playing field (which is huge for the nursing profession). He is so well respected. In fact, countless times I have overheard doctors state that Ray is the most important person on their team. Pretty incredible. Not only is he an amazing, compassionate, dedicated, committed nurse, mentor and person, he is making huge strides to help the nursing profession become more respected. Every day working with Ray I was touched by the care he demonstrated for his patients. He has inspired me to be better – in my career, in delivering patientcentred care, and as a human being.

Vanessa Madrid – Alberta Health Services

When I think about what makes a nurse a hero it is not, in my mind, solely related to providing care and services to the client. While that is indeed a vital and important nursing role, the support of others, whether new nurses, students, other health care professionals is what makes a nurse a hero. As her manager, I am daily honoured to have her not only as an employee but as a colleague. Her judgement and commitment to nursing as a profession coupled with her thoughtful and empathetic approach to all her interactions continue to motivate me and make me truly glad to work alongside her.

Wendy McElroy – Trillium Health Partners

Wendy works in the spirit of team collaboration and cares for her patients beyond what is required from our professional duties. Working nights can be physically and mentally draining, but she still manages to assist her colleagues. One example is providing peri-care on her partner's patient while she was on break (and then bathing him) instead of waiting until her partner returned and waking up the patient again to bathe early in the morning.

Kelly Freeman – St. Mary’s General Hospital

Kelly truly gives 150% percent of herself. One night shift we received a patient, sadly close to end of life. After medical assessment, the family wanted to take the patient home. A ride was not possible due to patient’s condition. Kelly being the kind person she is, allowed the patient’s family to bring their car into the ambulance bay and she physically helped lift the patient into the back seat for transfer to home. She called the family to ensure they arrived safely.

Dorothy Martin – Chatham Kent Health Alliance

Dorothy approaches each day, with enthusiasm and compassion. She is a leader amongst her peers and colleagues. On the Thanksgiving weekend, we had a new type 1 child diagnosed, and admitted to hospital on the Friday afternoon. The patient's family had not received the diagnoses, by the time our regular work day had completed, so Dorothy, – very willingly offered to come back on the Saturday – to meet the family, and do an initial teach of insulin etc. Dorothy has always maintained that our initial contact with the Type 1’s is so important from the get go… Dorothy – was also serving Thanksgiving to her family of 17 people that same day! A second example of her going above and beyond, is when she starts a patient on the insulin pump, she gives out her personal phone number and pager number, so the patients can contact her ANYTIME within the first 48 hours of starting on the pump – just for support and re-assurance. She has talked to MANY patients/family members well into the wee hours of the night, just to provide them with a listening ear, and to help support them on their initial journey with improving the quality of their life on the pump.

Nancy Timan – Providence Care, Kingston

I have had privilege of being mentored by Nancy entering into a field of nursing that was new to me, Geriatric Psychiatry. Nancy provided the softest landing for me with her compassion, understanding, attention to detail, excitement in teaching, love for the nursing profession and

Ailie Kerr Interior Health, Ponderosa Lodge

Dan Li (2) Runnymede Healthcare Centre

Olga Koveshnikov University Health Network, Toronto Rehab

Qunyu Li Mackenzie Health

Gabriela Kudiabor Runnymede Healthcare Centre

Yu (Kathy) Ma Sunnybrook Veterans Residence

Daniel Kwiatkowski Trillium Health Partners

Vanessa Madrid Alberta Health Services, Carewest Glenmore Park

Brian Laliban Trillium Health Partners

Dorothy Martin Chatham Kent Health Alliance

Ray Lam The Hospital for Sick Children

James Mastin Toronto Central Community Care Access Centre

Marcia Langhorn South West Regional Cancer Program Catarina Ann Lemos Sunnybrook Health Sciences Centre www.hospitalnews.com

Wendy McElroy Trillium Health Partners Melody McGregor Thunder Bay Regional Health

joy in mentoring in me. Nancy’s warm, enthusiastic, empathetic and personable presence creates a space to learn from her great wealth of knowledge. She motivates her colleagues to learn more and resolves conflicts and other difficult situations with remarkable patience and admirable tact. Hard-working and dedicated, she carries out her work at a high standard and is always striving to find ways to improve patient care. She deserves recognition for all her extra efforts and strong characteristics that are not listed on her job description.

Aimee Esmejarda – Runnymede Healthcare Centre

In all our interactions with Aimee, she demonstrates exemplary performance that goes above and beyond her outlined nursing duties. Aimee has embraced and utilizes a rehabilitation philosophy with all her patient interactions, helping each individual to achieve their discharge goals. On numerous occasions, she takes the time to conduct and encourage therapy with patients. She is especially diligent with those who are historically difficult to engage. She is compassionate and has an excellent bedside manner which builds rapport and encourages patients to participate and interact with her.

Natalie Sakin – Mount Sinai Hospital

Natalie’s patients usually come from remote places in Ontario. The patients are often very sick and diagnosed with cancer malignancies. She always does best to provide patients and families with the utmost comfort in their most overwhelmed and anxious state. Her knowledge and expertise in the field of peritoneal malignancies identifies her leadership abilities.

Marcia Bryant – Hotel Dieu Hospital

Marcia is an outstanding nurse and co-worker every day. She is always happy, compassionate and friendly. Always goes the extra mile to make life easier for everyone she comes in contact with. Her smile and sense of humour can melt even the most unwilling and uncooperative. Continued on page 14 Sciences Centre Maureen McLeod Frazer Almonte General Hospital Connie Morrison Southwest Regional Cancer Program Edsel Mutia North York General Hospital Marge Nap Bluewater Health Bonnie Nicholas Thunder Bay Regional Health Sciences Centre Colette Parker McKenney Creek Hospice Residence, BC Pernille Pedersen University Health Network, Princess Margaret Hospital

Franca Pellegrino Thunder Bay Regional Health Sciences Centre Leon Plukhovski Sunnybrook Health Sciences Centre Cathy Porteus Almonte General Hospital Lorna Quail Haro Park Centre Madge Reece (6) Humber River Hospital Pam Reese Kelowna Mental Health and Substance Use Eleanor Reyes Sunnybrook Health Sciences Centre Estrella Reyes Runnymede Healthcare Centre Lois Robinson Rouge Valley Health System Marilena Rutka University Health Network Toronto General Natalie Sakin Mount Sinai Hospital Rich Schregardus Markham Stouffville Hospital Kathy Shaule Trillium Health Partners Iceval (Icy) Simpson-Weir Runnymede Healthcare Centre Elizabeth Angela Smith Trillium Health Partners Lee-Anne Stayner University Health Network Princess Margaret Hospital Anne Stephens Toronto Central Community Care Access Centre Gina Stokes Sunnybrook Health Sciences Centre Nancy Timan Providence Care, Kingston Donna Tomlinson Runnymede Healthcare Centre Gurjit Toor University Health Network, Toronto Rehab Nicholas Tsergas Sunnybrook Health Sciences Centre Mary Tulk (2) Interior Health Penticton Health Centre Kate Uchendu (2) University Health Network, Toronto General Dragica Velimirovic Trillium Health Partners Mary Wadsworth Trillium Health Partners Millicent Walters Runnymede Healthcare Centre Lijuan Yang Runnymede Healthcare Centre Landy Zhang Haro Park Centre, Vancouver Barb Zita Mount Sinai Hospital MAY 2014 HOSPITAL NEWS


N14 National Nursing Week 2014 — S A L U T E Yue (Kathy) Ma – Sunnybrook Veterans Residence

My husband has been a resident in L Wing(LGSW) for 2 years and 5 months. Kathy has been Bruce's primary nurse for most of this time. An outstanding, true professional who cares deeply for the veterans in her care. She keeps me posted by phone when needed and we chat when I visit. She shows great compassion for my husband as his behavior is a challenge due to Alzheimers.

Lauren Edwards – Trillium Health Partners

I have been fortunate to work with Lauren and have seen her demonstrate a breadth of nursing skills and knowledge that is quite impressive. Her competence as a great leader and her willingness and enthusiasm to participate in building a stronger emergency nurse team through information sharing and the skills development of less experienced and beginning nurses is well respected amongst her peers.

Delia Ciano – McKenzie Health

My wife was rushed to Mackenzie Health with high fever. After necessary tests and medications, she was transferred to floor 4- East. The Nurse who looked after her was Ms. Delia Ciano. Her mindful listening, support and care towards my wife was commendable. Delia provided excellent clinical and emotional support. Above all, she is a knowledgeable nurse and my wife got appropriate care that was courteous, timely and respectful.

Joseph Gajasan – University Health Network

Transformational Leadership is what Joseph does on a day-to-day basis. For example, he helped a Partner in Care project that I’ve been working on for the past two years to become something much bigger and a lot more patients benefited. It became something much more innovative and creative than I anticipated. Joseph is a true Leader and I aspire to be like him one day and I’m encouraged to continue with my leadership development.

Kate Uchendu – University Health Network, Toronto General (2)

I have Sickle Cell Disease. I’d like to honor Kate Uchendu as a Hero because she is a good nurse. Since I met Kate 2 years ago, she makes me feel very secure. She is very concerned about my well-being. Kate has a big heart and she loves her work very much. She is doing everything to get more information for Sickle Cell and she finds what she needs to help patients be better in life. 2nd nomination: She is having a global impact through her work as she recently submitted an abstract that got selected for a conference abroad. Kate embraces academic excellence and seeks ways to embark on quality improvement for our clinic. She is leading other projects in the hospital such as the novel pilot project to enable Red Blood Cell Disorders patients have their crossmatch specimens drawn at centres close to home. This project, if successful (and I have no doubt with Kate on the project

Registered Practical Nurses Association of Ontario

Recognizing Nurses For Providing Leadership At The Point Of Care On behalf of the team at RPNAO, we’d like to take this opportunity to wish all our nursing colleagues throughout Canada a very happy Nursing Week. Nursing Week is a time when all the countries around the world pause to celebrate nurses and the important work they do. There are more than 35,000 Registered Practical Nurses (RPNs) working in Ontario today. And more than ever, these nurses are being asked to play key roles in diverse health care teams along their Registered Nurse and Nurse Practitioner colleagues and a wide range of allied health professionals. RPNAO’s theme for Nursing Week 2014 is “Leadership at the point of care. Ontario’s RPNs.” It’s a theme that celebrates the skill, expertise and dedication of Ontario’s RPNs, who, working alongside their peers in health care, demonstrate true leadership as they work to make positive differences in the lives of their patients, clients, residents and their family members. They demonstrate this leadership at the point of care in long-term care facilities, palliative care units, operating rooms, community care settings, emergency rooms and every other health care setting in which you will find a nurse. During this special week, it is our honour to recognize and thank all nurses and other health care practitioners for the important and selfless work they do. Sincerely,

The Staff And Board Of Directors Of RPNAO HOSPITAL NEWS MAY 2014

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it will succeed), will change transfusion practice as it will reduce patient wait times significantly.

Anne Stephens – Toronto Central CCAC

Watching Anne Stephens work with a client with aphasia, who is unable to speak, in order to perform a ‘capacity assessment’ to determine their ability to make and communicate decisions for themselves, is a remarkable experience. Her care, respect, patience, determination and creativity are all on display as she searches for the person ‘masked’ by illness and the inability to speak. Anne’s encyclopaedic knowledge, perfectionist drive and respect for clients and colleagues alike make her a very special member of the nursing profession.

Mary Tulk – Interior Health, British Columbia (2)

She works tirelessly to meet all of her client’s needs, going above and beyond on a daily basis for each and every one of them. She works with adults, children and pregnant women, helping them to manage their diabetes. On any given day you will find Mary in her office making telephone calls, or visiting one-on-one with clients, quite often during her lunch break or after hours. To top this off, after an extremely busy day she heads off to see clients in their homes for foot care. It is exhausting watching Mary as she never stops!! She is also a certified insulin pump trainer for the South Okanagan. All pump training is done on her own time. 2nd nomination: Mary is one of the hardest working people I know, and is extremely deserving of this award. She spends many hours counselling people with diabetes and helping them live healthy, happy lives. Mary is an integral member of the pediatric diabetes team. She is incredibly knowledgeable regarding this pediatric population and is always able to help the families work through the many issues that arise. She is often a voice of reason when dealing with the many teenagers in the program and a supportive listening ear for the parents.

Melody McGregor – Thunder Bay Regional Health Sciences Centre

Melody McGregor is a sexual assault and domestic violence outreach nurse here at Thunder Bay Regional Health Sciences Centre which means she not only a familiar face here at the hospital but also within the Thunder Bay community. While I am only an intern here at the Thunder Bay Regional Health Sciences Foundation she made time in her day to talk with me after I had missed a presentation she had given in the community that I wanted to attend. She took the time to explain what her role was within the hospital and the community, how her patients are affected and she still now always has time to chat quickly when I pass her office in the hallway in the morning. She works tirelessly with the most vulnerable of patients with grace and care and still remains passionate to her values and personal investment in the community to educate those about sexual assault, domestic violence and how to get help. If Melody was unable to do this our region would be less informed, less safe and less reassuring.

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Sarah Baird – Peterborough Regional Health Centre

Sarah has worked in the ICU for six years. She meets all of the aspects of a Nursing Hero as she is committed, dedicated, compassionate, and a nursing leader. Sarah demonstrates her commitment to nursing by actively participating in the operation of the ICU. She is a member of the Critical Care Operations Committee where she has advocated for the implementation of strategies to promote patient safety and the implementation of evidence-informed nursing practices. An example of this was the development of the Oral Care Policy. Sarah conducted a literature review, researched current guidelines and wrote the Oral Care Policy that has been adopted in the ICU. Sarah demonstrates her compassion outside of her ICU job. She has travelled to Honduras for three consecutive years, at her own expense, with “Friends of Honduran Children” to provide nursing care for those who lack access to fundamental health services. Her comment to me was that “these people give [her] far more than [she] could ever give them” – this statement reflects Sarah’s humble attitude about the contributions that she makes on a daily basis.

Paulina Bleah – University Health Network

Within just 6 months of joining University Health Network as a nurse at Toronto General Hospital, 22 year old recent Ryerson U grad Paulina Bleah knew she wanted to do more. So Paulina set out to solve recurring practice issues. The number one problem she identified on her ward was incontinence amongst the geriatric population, so she set about determining how to arrest the issue. With the support of her colleagues and her manager Paulina researched and wrote a proposal to be considered for a research scholarship under UHN’s Collaborative Academic Practice Fellowship Program. The Fellowship Awards provide funding to worthy projects allowing health care professionals to develop solutions to practice issues and advance practice. Paulina’s proposal was accepted, and she set about looking for solutions by reaching out to patients, and her entire health care team. Paulina’s intelligence gathering allowed her to zero in on the issue of geriatric incontinence on her floor – and that led to a sustained change in practice.

Susan Hamilton – Saint Elizabeth Health Care

As the new leader of client experience, I like to travel with front line staff while they deliver care to patients, in order to better understand the work and needs of the staff and the clients. I spent the better part of the day with Susan and was amazed by her compassion, creativity, and humility. In one trip, I saw (and heard) of three separate stories where she went well above and beyond the call of duty. One story: Susan’s patient, living in a low income area, had bedbugs, and could not find anyone to help get a new mattress or rid of the old one. Susan brought her own air mattress to give to the patient, while helping her to locate a new one that she could afford and get assistance in removing the old mattress. I am constantly surprised by the hardwork, compassion, empathy and creativity of our visiting nurses and staff, but Susan really stands out for me as someone H who gives more. n www.hospitalnews.com


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Marcia Langhorn RN HM

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Southwest Regional Cancer Program M

arcia has worked at the London Regional Cancer Program (and South West Regional Cancer Program) for over 25 years. Marcia began her career as a chemotherapy unit nurse and worked her way up to clinical manager for the chemotherapy suite. She is now a regional educator providing support to six satellite sites within the South West. Marcia has been instrumental in creating and promoting programs that allow patients to undergo chemotherapy treatment close to home. Care close to home allows patients to be supported by family and friends while receiving cancer treatment in a comfortable, familiar setting. Marcia was an integral member of the core project team that worked tirelessly to ensure the successful launch of the expanded chemotherapy unit at Woodstock Hospital. With her extensive nursing background and intimate knowledge of the cancer system in the South West, Marcia helped to mentor the nurses in the new unit to ensure patients would be receiving safe, high quality care at the facility. Those of us who are lacking a clinical background always look to Marcia for guidance and support. She never hesitates

to explain medical terminology and welcomes the opportunity to share the learnings she has acquired with colleagues and staff. Marcia has a special way of helping colleagues to understand without making them feel inadequate or inferior. She is an incredible teacher and mentor.

Marcia Exemplifies Leadership

In her roles as charge nurse and clinical manager in the chemotherapy unit, Marcia was highly respected and appreciated. She took an active role in orienting new nurses and training or updating others that required recertification. Marcia has an endless amount of patience and skill in teaching nurses and recognizing their individual learning needs. Marcia was always the go to nurse in the clinic when it came to questions about a particular treatment or clinical trial. She had an excellent rapport with all physicians in the clinic and would strive to accommodate urgent requests to get patients started on cancer treatment. Marcia often arranges her schedule to accommodate educational sessions across the region. She leads annual spill review sessions for providers and travels across the LHIN to ensure staff safety is a prior-

Educating for life

D’Youville offers choice for Canadian students seeking nursing degree Buffalo, N.Y. - D’Youville College, a small private four-year institution near the Peace Bridge in Buffalo, has become the school of choice for thousands of Canadian students seeking an education in health care and education. D’Youville created western New York State’s first four-year nursing program in the 1940s and today offers a complete array of nursing programs as well as other health care offerings. From Bachelor of Science in Nursing (BSN), Registered Nurse to a Bachelor of Science degree in nursing (RN to BSN), Master of Science in Nursing, Family Nurse Practitioner and a Doctor of Nursing Practice program, the college offers it all. D’Youville, named after a well-known Canadian Saint, makes it easy for Canadians to attend. Students enrolled in the RN to BSN program receive 50 percent off tuition; all other Nursing programs receive a 20 percent discount for Canadians and undergraduate scholarships go up to $69,000. In addition, there are Friday only classes to meet the needs of students who are working and clustered nursing courses on Thursdays and Fridays for graduate nursing programs. Over the past five years, D’Youville has invested approximately $70 million in new and upgraded campus facilities including new state of the art nursing simulation labs that opened last year featuring the full body high tech patient simulator mannequins that bring amazing realism to the nursing students today. These are the most advanced patient simulators available today. Recently unveiled this year was another state of the art Simulation Lab to help teach students collaboration with a variety of health care disciplines. These include pharmacy, physician assistant, physical and occupational therapy, dietetics, chiropractic and nursing, all taught at D’Youville. The students work together to treat a “patient” with specific symptoms. This lab features a simulated hospital room and another representing an outpatient clinic. D’Youville has been an excellent alternative for Canadian students for over 20 years. It’s within easy travel distance, affordable, with an accommodating atmosphere with classes taught by professors with clinical experience.

Visit us on the web at ww.dyc.edu HOSPITAL NEWS MAY 2014

ity. Marcia’s cheerful attitude when faced with a challenge is an example to others and exemplifies the leadership competencies championed at the London Health Sciences Centre. When Marcia is involved in a project or team, there is never any question that issues and challenges will be resolved.

Marcia is the conductor working behind the scenes to ensure these services are tailored to support patients and their individual needs.

Marcia Supports Patients, Families and Caregivers

Earlier this year, Marcia was recognized by Cancer Care Ontario (CCO) for her commitment and contributions to the Evidence based Care Program. The program completed seven new guidelines, three recommendation reports and updated and endorsed 10 additional guidelines. The documents are making a difference in cancer control in Ontario by providing guidance for clinical care, improving access to new effective drug treatments, and informing administrative and policy decisions aimed at improving the quality and safety of patient care. Marcia’s role on this committee helped ensure physicians and patients in Ontario have the high quality tools they need to facilitate and access the best in cancer care practice.

Marcia Mentors & Coaches

Marcia provides timely support, orientation and education to new and experienced nurses when new regimens or programs are introduced. She always makes herself available for consultation and assistance and is skilled in determining the unique learning needs of patients and/ or nurses. Marcia continues to organize nursing mentorships for CON(C) certification, regional CCO community of practice workshops for symptom management, and regional South West workshops aimed at improving patient and provider safety. She has worked to incorporate the CCAC program into community of practice meetings. Marcia has also been instrumental in organizing and coordinating many CME courses for nurses, pharmacists, community oncologists, internists and GPOs over the last several years.

Marcia Responds to Patient Needs

Marcia was involved in the expansion of satellite clinics in the South West region. She possesses a leading, supportive

and caring personality that translates into her interaction with patients. Marcia works closely with stakeholders and partners in the region to ensure the models of care that are being implemented support the dynamic of the community and the culture of the hospital. Cancer patients who are receiving treatment in Woodstock (among other hospital sites) have commented about how care close to home has eased the cancer burden in insurmountable ways. Marcia is the conductor working behind the scenes to ensure these services are tailored to support patients and their individual needs. Marcia has visited every emergency department in our LHIN to provide education about the Fever Card that is given to patients receiving chemotherapy. This important patient centered initiative, championed and promoted by Marcia, has resulted in more rapid and appropriate care for cancer patients presenting at emergency departments across the region. Marcia believes that the interest and safety of the patient is a priority and goes out of her way to ensure regional sites have the educational tools required to meet established targets. When Marcia worked in the chemotherapy unit, colleagues commented about her compassion for patients. She has a particular fondness for the elderly and would ensure they were comfortable and safe while in her care. Although there was often pressure to work at a faster pace, Marcia never rushed through the process of administering chemotherapy. She made sure that each patient understood their treatment plans, and addressed questions and concerns with empathy and kindness. Marcia always exhibits great professionalism as a nurse and great care as a caring person to those she serves.

Support for Marcia Langhorn:

“It is not exaggerated to say that over the years Marcia has been the glue that keeps our regional systemic therapy providers together and keeps the lines of communication open.” Dr. Ted Vandenberg, Medical Oncologist, London Regional Cancer Program “Marcia is an amazing nurse, woman, and friend.” Connie Morrison, RN, London Regional Cancer Program “People are drawn to Marcia from all walks of life for exactly one reason she truly cares and gives a “human touch” to every situation she encounters.” Lynn Wareing, RN, Woodstock Hospital “All of our nurses that have trained with Marcia agree that her wealth of experience and compassion is reflected in her teaching methods. She is a great mentor.” Barb Pletch, RN, Listowel Wingham Hospitals Alliance As outlined in this letter, I feel that Marcia Langhorn is a deserving candidate for a H Nursing Hero Award. n Nominated by: Shari Beaton, South West Regional Cancer Program www.hospitalnews.com


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H E R O E S — National Nursing Week 2014 N17

James Mastin

Palliative Care Team, Toronto Central Community Care Access Centre s a nurse working in a busy I really notice James’ remarkable comemergency department, James mitment to his clients when he cares for was devastated to see people some of our city’s most vulnerable people. brought to emergency, only A number of his clients are homeless, or to die in a hallway, when they could have dealing with addictions or mental health stayed at home if they and their families issues. His respectful and wholehearted had been better prepared and had the right treatment of these clients, who many of supports in place. us might see as outcasts, is humbling. As James’ conviction that things could be he does with all his clients, he makes sure better led him to us, and his current role at these clients understand their diagnosis, the Toronto Central Community Care Acits prognosis and their options, and he encess Centre (TC CCAC), where he sures he understands what’s most has been a nurse practitioner with important to them. His dedicathe palliative care team since tion is remarkable – he will truJanuary 2012. ly do whatever is needed and E L B A HONOUR N For the period of time considdisplays incredible creativity in MENTIO ered for this award, I can tell you finding solutions, connecting James has made an incredible with new people when needed. difference in caring for palliative In the past year, James has care clients and their families, and also done pioneering work as the demonstrated the qualities that make him first nurse practitioner on the Palliaa truly extraordinary nurse. His wholistic tive Care team and as a member of the TC view and training mean that he cares for CCAC’s Interprofessional Specialty Team. the whole person: not just the illness. James’ exceptional interpersonal skills James’ nursing care combines a high have allowed him to be an ambassador for level of professional and clinical knowl- the role, which is not yet widely underedge and practice with a compassion that stood, even among health care professionis remarkable to witness. He says he thinks als. He has established very effective workabout the care he would want for his fam- ing relationships with external partners. ily, and lets that guide him. His knowledge and skill as a clinician has

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established not only credibility for himself, but for the profession. James has been a generous colleague and encouraging mentor to new nurse practitioners on his team; there are now five, based on the success of his pioneering work. He has also supervised a number of students in the nurse practitioner program at a local university and has been asked to speak at a number of recent conferences. I can tell you James is passionate about nursing, and finds it a privilege to work

with clients facing the end–of–life. Incredibly, on his vacation time, he goes to northern Canada to communities without permanent primary care providers, to give them invaluable service for a few weeks at a time. In his skill, compassion, holistic approach and innovative determination, James truly exemplifies the best of the H nursing profession. n Nominated by Josie Barbita, Director of Client Services, Professional Practice, Toronto Central CCAC

Graduate School

take your career to the next level D'Youville College Salutes Our Ontario Nursing Graduates UNDERGRADUATE PROGRAMS Nursing (2-yr. RN to BSN) Nursing (4-yr. BSN) MASTER’S PROGRAMS Community Health Nursing • Advanced Clinical Nursing • Education • Management Family Nurse Practitioner

THE U.S. UNIVERSITY STUDY OPTION HEALTH CARE PROGRAMS for

High School Students • Transfer Students University Students • Graduate Students Working Professionals www.hospitalnews.com

DOCTORAL PROGRAMS Nursing Practice (DNP) ADVANCED CERTIFICATES Clinical Research Associate Family Nurse Practitioner (post-master's certificate) Nursing and Health-Related Professions Education

716.829.8400 www.dyc.edu MAY 2014 HOSPITAL NEWS


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Angela Smith RN Addictions & Concurrent Disorders Centre, Trillium Health Partners would like to nominate Elizabeth Angela Smith for the Nursing Hero Award. I am a patient at the Addictions & Concurrent Disorders Centre at Trillium Health Partners, Credit Valley Hospital site for the past 3.5 years. This is where I first met Angela Smith. A few words about myself, I am male, 59 years old, married 35 years. I have 2 sons and 1 daughter. My middle son passed away 3 years ago of cancer. My disease is addiction. After my son passed away I started drinking quite heavily and BLE HONOURA N hit rock bottom. It was so bad IO MENT that I would black out, fall and could not remember anything. I was out of control, felt helpless and was desperate. I suffered and my family suffered because of me. she helped us understand that. Angie gives This is when I met Angela Smith for 110 per cent of herself and is very mindful the first time. She is a therapist who helps and attentive to other people’s needs. Angie is a very empathetic and caring people with the disease of addiction in a compassionate and non-judgmental way. person with a very big heart. She is a very She saved my life! She has a way of making good listener who lets you talk and vent if everyone feel comfortable and special. Ad- you need to, she is the kind of person that diction affects everyone in the family and you can talk to. Continued on page 20

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Rich Schregardus RN Vocal. Visible. Respected. Join the largest professional association of Nurse Practitioners in Canada.

Since 1973, NPAO has been working to help achieve the full integration of Nurse Practitioners across the healthcare system to ensure that Ontarians receive the best possible care by the most appropriate team player. If you are an NP or student, join NPAO to: • Influence health system change through involvement in advocacy and sector negotiations. NPAO is recognized by stakeholders and government as the professional voice of NPs. • Get support from colleagues. Join a professional community for networking and mentorship at local, regional and provincial meetings. • Be the first to know through our members-only website and message board as well as e-bulletins and social media (follow us on twitter!) • Polish your practice with conferences, webinars, OTN sessions, best practice guidelines, and clinical updates. • Be recognized as a shining star through awards, bursaries and media spotlights. • Build public awareness and increase the profile of NPs through media coverage and print materials. Offer your expert NP opinion on common health-related questions on our Ask the NP section. • Re-orient our system to a health-care system!

www.npao.org email info@npao.org call 416-593-9779 HOSPITAL NEWS MAY 2014

Emergency Department, Markham Stouffville Hospital

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hen most of us think of a nurse had stopped breathing and Rich began going above and beyond, we performing CPR on my baby. imagine them in the middle of I watched in absolute terror as Rich mea chaotic emergency depart- thodically breathed into Jack’s mouth and ment, or in a stressful operating room, or performed chest compressions. In that momaybe even sitting next to a patient’s bed ment, all of his training and thinking was comforting them. going towards saving my son. I had the opportunity to witness someAlthough it felt like an eternity, Rich one going above and beyond at the side of was able to quickly resuscitate Jack and the road as I stood by and watched a very shortly after that police, fire and nurse save my son’s life. ambulance arrived. Last summer, I was driving Rich interacted with the home with my toddler Jack, who other medical personnel and BLE relayed critical information was one and a half years old. HONOURA N IO T We were just around the corner about the situation and Jack’s MEN from our house when I looked vitals. It was like he was in the in the mirror and noticed he was middle of his familiar environhaving a seizure. ment in the emergency departI frantically moved through traffic, ment caring for a patient, except looking for a safe place to pull over. In- we were at the side of the road as traffic stinctually, I pulled Jack out of his seat and whizzed by. tried to get him to a safe place to lay down. Jack was taken to the hospital by amPanic was starting to set in for me. bulance and Rich continued on his way A motorist in the car directly behind me home. had pulled over to see if I needed any assisIt was an extraordinary few moments tance. Rich Schregardus is an emergency when our lives intersected. room nurse at Markham Stouffville HospiOn what should have been a very ordital who I think was on his way home from nary day, I was blessed that someone like his shift at the hospital. Rich crossed paths with me and my son Taking one look at me and one look at and that he was a nurse. And more impormy son, Rich clearly knew the situation tantly, he was a nurse who cared enough to H was very serious and told me to call 911 stop and save my son’s life. n as he assessed Jack. Within minutes, Jack Nominated by: Karen Matthews

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H E R O E S — National Nursing Week 2014 N19

Are you new to Canada? / Nouveau au Canada? Do you want to improve your workplace communication skills?

Participate in free Occupation-Specific Language Training courses Workplace Communication Skills for Health Care • • • • •

dental hygienist medical radiation technologist nurse personal support worker sleep technologist

Workplace Communication Skills for Interprofessional Health Care Providers • • • • •

dietitian nurse occupational therapist physiotherapist social worker

Visit http://www.co-oslt.org for more information Pour de plus amples renseignements sur les formations francophones consultez : http://www.lacitedesaffaires.com/service-immigrants/flap.htm To qualify, you must have training or experience in the fields listed under each course above. Also, you must be a permanent resident of Canada or protected person and your English/French must be at an intermediate level (Canadian Language Benchmark 6 – 8 for courses delivered In English or Niveaux de compétence linguistique canadiens 6 – 8 for courses delivered in French).

The Nurse Practitioners’ Association of Ontario Celebrates

National Nursing Week 2014 We applaud our nursing colleagues as Expert Clinicians! Go to the “Ask the NP” section of our website where experienced NPs provide answers to your common health-related questions

We salute nurses as change agents creating a better future! Better Care. Better Value.

We commend our nursing colleagues as researchers, educators and life-long learners!

See how you can support a plan from the Province’s Nurse Practitioners for a Healthy Ontario

Hold the date for the NPAO Annual Conference Nov 6 to Nov 8, 2014 at the Hamilton Convention Centre. This year’s conference features 12 pre-conference workshops including workshops on casting, joint injections and MSK assessment. Sessions also include: liability and risk management, research on the cost-effectiveness of NPs and an update on regulatory issues.

At NPAO, we believe that all RPNs, RNs and NPs are heroes

www.npao.org or email info@npao.org or call 416-593-9779

Congratulations to all Award Winners and Nominees! You Inspire Us! www.hospitalnews.com

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Barb Zita RN Endoscopy, Mount Sinai Hospital

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n behalf of the entire Endoscopy Department we heartily submit our tribute to Barb Zita for consideration of your Nursing Hero award. Judith, one of our nurses explains, “I’ve seen her change people, I’ve seen people leave here for the better.” We could not agree more- so this is our thank you to an exceptional nurse, one so deserving of this generous award.

Confession

I sit silently when I know I should speak, overwhelmed by intimidation… Our endoscopy unit has a host of visitors today. They are the brass, a compilation of representatives that run the gamut from department heads to the hospital CEO. They come to seek quality assurance, investigators of the attributes that earn the hospital its high standard. Upon hearing the stories of our units’ cohesiveness, superior performance and reputation, their final question is: “What do you think it is that makes endoscopy such a special place?” their query is met with smiles and unarticulated ponderings… My mind automatically calculates, for amid the myriad of possibilities, there is one consistent…. one who sets the bar….

one who brightens each day, one like no other. Barb Zita is a nurse who radiates warmth. Barb is a nurse who soothes the nerves of the anxious, reassures the intrepid, and leads the inexperienced. Barb is a teacher to students and peers alike, a nurse who takes pride in her work, a veteran, guided by principles honed by experience, respect and integrity. If you were to meet her, you would smile, for her energy could light up a room. I smile to myself when I see her with patients. I see her transform tense situations with an effortless sense of calm and expertise gilded with humor, which could tame the most skittish of beasts. Barb is our teacher. Barb is our compass. Barb is our mentor. This day I will not remain silent, this day, I will make public the efforts of a nurse who has dedicated her life to the service of others. So here it is brass, Mount Sinai hospital is a better place because of the efforts of nurses like Barb Zita. A true nursing hero…. decorated by countless unspoken medals of Honor.

The Teacher

I find her sitting in the lounge. She seems frightened of her own shadow, a palpably awkward girl. The tell tale badge of a

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nursing student adorning her uniform is an unnecessary billboard of her junior status. She confides that she is worried about the placement ahead, disillusioned by past nursing preceptors that have been less than kind. She is contemplating giving up, contemplating leaving the profession rather than face another harsh encounter. Unbeknownst to her, a saviour of sorts was awaiting, a teacher who had guided and supported so many before her, a teacher who can be credited with molding so many young nurses. That teacher was Barb. While other nurses recoil at the added work and stress of overseeing the education of student nurses, Barb continually assumes the role. I see her throughout her placement with Barb. She is engaged, encouraged, and supported. I see her observing her mentors amazing style with each patient. I see her emulating Barb as she executes skills with compassion and respect. I see her gaining confidence with each passing day. I see her empowered… I see her change. I find her sitting in the lounge. This day, she wears the attire of another hospital, the nursing student badge now replaced with a staff badge. She is a confident, composed, young woman. She has come after a night shift at a trauma unit. She has gone on to do great things, gone on to be an asset to this world. She confides that she is here to see Barb, here to thank Barb. To honor a nurse, who showed her warmth, showed her patience. Showed her she had what it took to become a great nurse. “I will never forget her,” she said… I agreed- for no one ever could.

The Gift

“Jane” comes to us again. She comes to us many times, with many faces. Sometimes, she is a shivering child, at others she is brash and spiteful. She is trying, demanding, and has worn many nurses down. Many would avoid her, busy themselves elsewhere. Most would be pushed to treat her firmly, deal with only

the medical matters at hand and in turn, fuel the fear that lurks beneath the surface. Barb welcomes her again. She smiles and speaks to her kindly regardless of the face before her. She maintains control, expertly diffusing any outbursts. Barb touches her hand, calms her, speaks to her like she is real, speaks to her like she is special. That is Barb. A lion tamer of sorts… nurturing the shivering child, diverting the brash and spiteful. Barb has a gift that comes only to those who have an insight into the experiences of others – the gift of empathy – a gift that she’s happy to give to all those around her.

The Acts

There was escalating drama in Room 1. A patient was in trouble. A sea of green and white coats instantly descended upon the room. The drama had a happy ending, but the tumultuous events in the room have unknowingly become a source of fear for nearby pre and post procedure patients, and, terror for the family of the patient involved. I brace for the onslaught of reassurance and explanations that will surely be due to those who wait… as I enter the patient area of the clinic, there is not fear or terror, but rather, there is a sense of peace and calm. All I have to see is Barb attending to them, and I understand why. While others rushed blindly to fulfill a role, Barb calmly took hers. Hers was one that was without the accolades of “saving” a patient – she knew those roles were taken care of. Rather, hers was a role of unfaltering reassurance and encouragement to those vulnerable to the insecurities of being in a hospital. She kept the home fires burning, a most genuine and noble of acts. H Barb is a hero. Our hero. n Nominated by Cindy Campbell and the entire Endoscopy Team.

Elizabeth Angela Smith Continued from page 18

When you speak to Angie her expertise steps forward, she will explain why I am feeling this way and how to work out my problems without using substances. It’s not just problems you can speak to her about but also everyday life experiences that come up and you have a problem resolving – and she listens without judging my feelings. Angie is a wonderful advocator; if a patient needs letters or help with legal documentation for work, she will help you and fight for your rights. It is difficult when you have an addiction and have no control of your life. Angie has helped me get control of my life and made me dig deep into my feelings of why I had my addiction, besides the passing of my son. I am now clean and sober for 3 years 5 months thanks to

Angie’s help and guidance. She is very dedicated and compassionate in helping patients at the Addictions & Concurrent Disorders Centre. I still see her at least once a week for guidance and counseling. Angie has a way of restoring faith, selfdignity and respect in everyone she sees. And because of her work, I am a better husband, father, and a friend. She inspired me to be the agent of hope to others who suffer with addiction and now I am a volunteer at The Addictions and Concurrent Disorders Centre because this work cannot be done alone. By nominating Angie I want to help break down the stigma of Addiction & Mental Health and recognize a nursing H hero. n Nominated by Carmen Prezio www.hospitalnews.com


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H E R O E S — National Nursing Week 2014 N21

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Maureen McLeod Frazer RN

Obstetrics Program, Almonte General Hospital would like to nominate Mau- particular she aspires to be an expert lactareen McLeod Frazer as a Nurs- tion consultant. ing Hero. Maureen and I have shared many tours Maureen joined Almonte on our five bed Obstetrical unit. I recall General Hospital not long ago. She chose one night shift when we were experiencing our facility after being an inpatient here torrential storms and every expected baby and explains that she was so impressed decided to be born that day/night. Mauby the hospital she decided to take on the reen and I came on shift with a patient challenge of a community hospital setting. load of 11 postpartum moms and babies. We have been amazed by her commit- We were over capacity which necessitated ment to the nursing profession and her pa- us completing care of our postpartums on tients. She openly shares and teaches her the Medical/Surgical inpatient unit. I was speciality in neonatal care and children's the junior nurse to obstetrics and initially medicine. felt overwhelmed with the workload. We continue to be amazed by her Maureen displayed such control ability to accept new challenges and organization of our workload with ease, a calm nature and that I was compelled to equally how she has the ability to enmeet the challenges of that E L B A R gage others without them feelshift. When I returned from U O HON ing intimidated. Maureen acthe medical floor where we had MENTION cepts situations as they present put four moms and babes, I saw themselves with eagerness and Maureen setting up for a delivflexibility.Maureen accepts these ery. I did not believe her when challenges willingly and engages the she told me that she had received a team to work together in a collaborative call from an expecting mother who called approach. Maureen is reflective of the care while on route to a tertiary centre statshe provides and takes on any situation ing that she didn't feel she would make with a problem solving attitude. She en- the drive and was coming to our hospital gages others in a unique fashion as to illicit because she felt she was going to delivcooperation and camaraderie to finding a ery right away. Maureen expediently and solution. Maureen is a master in multitask- skilfully prepared for the patient and she ing and is in constant motion when she is prepared me. We readied for a preterm deon shift. Her energy and cheerful, teach- livery, secured a physician and awaited our ing manner is appreciated by all who are in patient. The patient arrived soaking wet her circle of care. Maureen describes her and afraid. Maureen easily calmed the padesire to care for maternity patients and in tient and assured her that all was well and

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that we were prepared for everything. I was most grateful that Maureen was on shift that night to care for this distressed woman and to receive the preterm baby that arrived. Her knowledge, skill and calming nature made it seem so easy. I as well as my team have commented numerous times how reassured we all are that Maureen is on duty when a sick baby arrives. Maureen attributes her skill to her insatiable appetite for new knowledge and a commitment to ongoing learning and teaching. She recalls a mentor and friend who exampled for her the ease and skill of a nurse managing a choking child. This event inspired Maureen to choose a nursing profession in neonatal care. Maureen's ability to teach and instruct other nurses comes from a desire to overcome her fears as a public speaker. She recalls how she challenged herself to overcome that fear by involving herself in a nursing education program in Hamilton. Maureen overcame her fear of speaking in public by continually challenging herself to complete education, in-services and public speaking events. Maureen's commitment to the nursing profession, her ability to effectively teach and her gift of being able to identify challenges and enlist cooperation in determining solutions to those challenges with a calming nature facilitating learning and are valued and unique qualities. Maureen has saved the lives of many sick babies and children and she has effectively assisted team members to care for our sick

babies. Maureen is now a certified Neonatal Resuscitation Program (NRP) instructor, providing course instruction for nurses and physicians. Maureen is a valued professional who inspires change, motivates us to have a continuum of learning, a safe environment for patients and enlists the cooperation of the interdisciplinary team. She goes the extra mile, invests volunteered hours of service to the betterment of her colleagues learning needs and strives for excellence in care. There is no challenge too big for Maureen to tackle. I am grateful that I have been afforded an opportunity to thank Maureen in this written format to acknowledge her contribution to our nursing profession and let her know that she is a Nurse Hero. I want the world to know how honoured we H are to have her share her gifts with us. n Nominated by Susan Breckenridge

OUR NURSES

STAND OUT! Thank you for putting patients first. At North York General Hospital, our teams are making a world of difference. Caring, skilled and dedicated, our nurses play an amazing role in achieving a new standard of excellence in integrated patient-centred care. On behalf of the people we serve in one of Canada’s most diverse communities, we recognize and appreciate everything you do each day to exceed the expectations of patients and their families.

TAKE A BOW. YOU’RE AMAZING. To find out more about our outstanding nursing team, visit us online.

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www.hospitalnews.com 2014-04-29 12:50 PM 2014-04-29 9:42 AM


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The Nurse By Roopdai Mohotoo and Nita Marcus

Florence Nightingale, the lady with the lamp, Mother Theresa in the refugee camp, Caring, compassionate, gentle and kind, A more noble profession, one could not find. The nurse is the doctor's eyes and ears, Records any changes, allays patient fears, Monitors rhythms, takes vital signs Administers drugs, sets up IV lines. The nurse is highly trained in her skills, To assist in the healing of wounds and ills, In the OR, wards or critical care, Her presence unnoticed because she is always there. With devotion and pride, she nobly serves, Though pressures, demands, may fray her nerves The nurse lowly paid, in gold is her worth, For she's truly god's angel sent down to earth by.

Arden Hamilton RN

North Bay Health Sciences Centre

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entered the AIPU for treat- cess certain treatment options as well as ment and intervention to accessing certain privileges. She continumanage my depression in Oc- ously rallied for so many things that would tober 2013. That is when I met improve the quality of my life. Feeling like Arden. Over the next few days I was able I matter has been eye awakening. Arden to explain an issue I was having regarding would constantly push me forward, helpmy children. Arden took it upon herself to ing me to exist without fear. She saved my contact the person needed to resolve the life. Being without a voice for 32 years to issue. Arden was not required to do that meeting this lady and her allowing me to because she wasn't my direct nurse. She have such a simple thing, like an opinion, had her own case load of patients. helped this change in me. That right there touched my During my 90-plus day stay I had heart. I had to thank her for many nice nurses, but it was Arbeing so kind and helpful. It den that constantly went that E L B A was selfless. extra mile. Not only did she do R U O HON N At the time I was admitthat but she was extremely humIO T N E M ted, I was worthless, nothing, ble about it always. All the while, alone, and dreadfully sad. She she dismissed this truly amazing gave me this hope and a glimand kind behaviour as just part of mer of positivity that had been her job. If every nurse put forth half clouded by my depression and past abuse. the effort Arden does, healthcare would Further along during my stay I suffered a be forever changed. setback due to the loss of an integral key Because of Arden, I know I matter. I player on my health team. Seeing how know I have worth. I know that there are distraught I was, Arden insured my safety amazing people in this world who are willby following protocol. Since I was to be ing to do whatever it takes to change a under constant supervision the next day life – my life. That is why she is my nursshe became my nurse. During that time ing hero. I cannot ever thank her enough she spent over four direct hours with me, for what she has given me, which in turn listening, relating, helping, and educating extends further to my children. They have me on the steps my new doctor wanted me a mother because of her. I am forever to take. She had this ability to get me to grateful. open up about the deepest things in my Thank you for reading my story and life. Her calmness and knowledge of dif- I hope she gets the recognition she deH ferent situations made it that much easier. serves. n She played a key role in helping me ac- Nominated by Laura Albert

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N24 National Nursing Week 2014 — S A L U T E

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Ethics 13

A first for health ethics in Canada By Kevin Reel

Leaps of faith are not something that ethicists tend to take very often…being more inclined to rely on thoroughly thinking through things. But a leap of faith might well have been what was taken as the Canadian Bioethics Society, in collaboration with the Nova Scotia Health Ethics Network, launched the inaugural National Health Ethics Week. How could anyone really know what it might end up looking like? I have heard the idea suggested for a few years now, but it had never actually been ‘declared’ until 2014. That old adage ‘build it and they will come’ may have manifest this time as ‘declare it and it will happen’! It was declared and it happened. Or rather, it was made to happen, and successfully. With the week landing in the calendar from 2-8 March, and adopting the theme ‘Health ethics in Canada – from coast to coast to coast’, the website lists almost 30 organizations large and small that participated. The organizers described it as ‘organized to raise awareness of health ethics issues that are important to Canadians and to provide a time for health regions and facilities, educational institutions, health care professionals and community organizations to host and take part in events that explore these issues.’ The registrants did range from across most of the country – from Nova Scotia and Newfoundland and Labrador on the east coast, to many sites up and down Alberta and to the shores of Lake Ontario. Saskatchewan and Manitoba were also represented, and there was national representation in the form of the Canadian Institutes of Health Research. Among the nearly 50 sessions listed on the events page, topics ranged from allocating scarce resources, end of life issues and moral distress among health care providers to research ethics and governance of the health professions to straightforward opportunities for folks to meet their local ethics team. Check the varied events for yourself at http://www.bioethics.ca/ethicsweek.

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Teleconferencing technology enables many to join the sessions from small and remote settings – where such ethics content may be less easily sourced. While the week might not have literally achieved the coast to coast to coast theme (though that may well have happened – I don’t have access to those details), what is probably most useful about such coordinated events is that teleconferencing technology enables many to join the sessions from small and remote settings – where such ethics content may be less easily sourced. Various provincial telehealth services did plenty of coordinating to make simultaneous webcasting happen for many sessions. And a further possibility for any individual or groups was to join some events by tollwww.hospitalnews.com

free telephone line. With the presentation materials offered in advance, there was no need to have access to telehealth services to join in – just a phone. And that willingness to share presentation materials means there are ongoing benefits as well – the open exchange of the materials either in advance, or after the fact upon request, shares the chance for deeper pondering of the issues with more people. In addition, some of the events will be archived for future viewing on the various telehealth websites. It’s not likely possible to calculate the

full impact of the week across the country. Even the posters in the elevators advertising the week and local sessions got people talking and thinking in the places I work. Our efforts to pull it together locally were rewarded by both the presence of new faces I’ve not seen before and the teleconference connections to groups and places I have not heard of before. So do take the time to look at the list of events, and don’t hesitate to contact the participating organizations if you might like to have further information. And keep your eyes open for next year’s Na-

tional Health Ethics Week – it’s likely to build on the success of the first year and offer plenty of thoughtful explorations of the ever more complex field of health care ethics. You don’t have to organize a presentaH tion to be a participant – only connect! n Kevin Reel is a Clinical and Organizational Ethicist at Southlake Regional Health Centre and Mackenzie Health and an Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto.

“ Focus on the things you can do, not what you can’t, and you will find, just like I did, that life is fantastic.” – Danny McCoy

Danny McCoy was rendered a paraplegic in a terrible car accident at the age of 43. Before the accident he was an avid sailor. After the accident, Danny became one of the top ranked competitive disabled sailors in the world. He’s also the founder of the Disabled Sailing Association of Ontario and one of the sport’s foremost international ambassadors. Thomson, Rogers is a proud supporter of The Disabled Sailing Association of Ontario. We are honoured to have represented Danny McCoy in his lawsuit and to count Danny as a friend and one of the many everyday heroes we have been able to help.

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14 Data Pulse

Timely organ transplants

save lives

By: Brent Diverty

ood news: More Canadians are making living or deceased organ donations, helping to meet Canada’s need for organ transplants and improving the quality of life for patients. Less encouraging news: A big gap remains between donations and need, and compared with other countries, Canada still has a long way to go. CIHI’s recent report Treatment of EndStage Organ Failure in Canada, 2003 to 2012 rounds up the data on organ transplants for the past 10 years. The report offers a hopeful picture for Canadians and important insights for health care leaders and policy-makers.

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Worth mentioning

CIHI’s report reflects a shift in living donor generosity—most notably, a 114 per cent increase in non-related living donors in Canada since 2003. Also worth noting is that young Canadians, from birth to age 39, comprise Canada’s largest group of living organ donors, followed closely by those age 40 to 49. Perhaps the most significant finding is that the rate of deceased donors has risen steadily over the past decade. For the

first time in recent years, the number of deceased organ donors in Canada has exceeded the number of living donors. This is important because deceased donors can provide up to eight organs for transplant to Canadians in need.

Waiting for organs

The positive numbers in CIHI’s report may be explained partly by a rise in the number of government advocacy initiatives, like easier online registration for organ donation. Added to that is heightened public awareness due to greater media coverage and social media campaigns. However, even with the increases in organ donation numbers in Canada, particularly over the past four years, there has still been a shortfall: for each organ group— heart, lung, liver and kidney—there is an equal or larger number of Canadians on a waiting list for organs. The human cost is reflected in the number of Canadians who die while waiting: 230 people in 2012.

Susan’s story

Susan McKenzie is the senior director of development for the national office of The Kidney Foundation of Canada. She’s

also a transplant recipient. Susan explains that her health care team originally aimed to do a pre-emptive kidney transplant to circumvent the effects of her familial kidney disease. However, in 2009, after 10 years of relatively little change to her health, Susan’s disease suddenly progressed—too rapidly to find a compatible organ donor and get a kidney transplant. Before she knew it, she was on dialysis. “Almost overnight, I went from enjoying good health to going for dialysis three times a week,” she explains. “It was a difficult adjustment.”

A new perspective on life

Susan began her search for a donor. Because of the nature of Susan’s disease, her blood relatives could not donate a kidney. Instead, she asked friends and other family members. Being her own advocate, she claims, was a crucial component to the success of her search. Six people came forward and the testing process for organ compatibility began. “Just knowing that

Canada’s deceased donor rate still lags behind other countries. people were there and being tested helped get me through,” Susan says. “It was like a light at the end of the tunnel.” Just over a year later, Susan had a new kidney—and a new lease on life. And she’s been healthy now for four years. “The whole experience has changed me and given me a new perspective,” she says. “Getting a transplant changes the way you H look at the world.” n Brent Diverty is Vice President, Programs, Canadian Institute for Health Information.

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From the CEO's Desk 15

Supporting the quest to live fully By Dr. Gillian Kernaghan

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Chronic illness financially accounts for 87 per cent of disability costs and consumes 67 per cent of direct health care costs. On October 10, 2013, the hospital officially opened a new, 42,000 square-foot central outpatient area purpose built for the treatment of complex medical and chronic disease. This opening represents an important juncture and a new era for St. Joseph’s Hospital brought about by a 15 year-odyssey of hospital restructuring and renewal in London. The hospital, one of five sites that make up St. Joseph’s Health Care London, has made the transition from acute inpatient care to specializing in minimally invasive short stay and day surgery, and outpatient treatment of complex medical and chronic disease. With this new role, and an innovative philosophy and approach to providing care, St. Joseph’s is redefining what it means to be a hospital. Chronic disease management is a critical area of focus whose time has come. One in five Canadians is living with chronic disease and the numbers are growing. So too is the burden of chronic illness – on people’s lives, the economy, and on the health care system. Chronic illness financially accounts for 87 per cent of disability costs and consumes 67 per cent of direct health care costs. St. Joseph’s Hospital is home to a broad range of ambulatory medicine programs for chronic disease with a common goal – to provide and coordinate care in new ways focused on each person’s multiple, complex continuing needs and individual priorities. This means recognizing that patients are coming to us with more than one chronic www.hospitalnews.com

disease that requires team work across programs, across sites, and with our community partners. It means multiple appointments on the same day during the same visit and finding new ways to deliver care that improves access, outcomes and quality of life for patients. It means truly understanding the patient experience. This takes a fundamental shift in health care delivery for chronic disease and we are taking those steps. Our commitment is entrenched in our strategic plan – integrated chronic disease management is one of three areas of clinical focus for our organization. This means teams are provided the capacity to do this important work. A Medicine Services Chronic Disease Management Planning Team has developed a model of care based on the Chronic Care Model (CCM). This conceptual model has been adopted as the basis for planning chronic disease management services worldwide. It addresses issues such as adherence to practice guidelines; care coordination; followup to improve outcomes; and patient education to help individuals self-manage their illnesses. A survey of our ambulatory medicine clinics was conducted to assess our adherence to the CCM model from the patient perspective. The Patient Assessment of Chronic Illness Care (PACIC), a standardized measure of care delivery, was used. While our programs rated well against comparators, there is work to be done. These results now serve as a baseline to address and evaluate improvements to care as our new model of care is implemented. It’s a significant undertaking. The ambulatory medicine programs at St. Joseph’s Hospital, which serve a vast region of Southwestern Ontario, see a combined total of about 84,000 patient visits each year. In addition to new models of care delivery, other components of our focus on chronic disease management include teaching, research to improve outcomes, and regionwide collaboration to improve the health care system. There have been some exciting, early accomplishments. A new, robust referral process has been implemented in our Pain Management Program to improve our response time. This includes a single, standardized referral form and consistent triage process. Also implemented were reminder calls for patients and a protocol for unconfirmed appointments to be filled with patients on a call list. As a result, we have seen a 10 per cent increase in the number of new patients over the same period last year. The reminder calls are a major contributing factor, reducing the ‘no show’ rate for new referrals by a staggering 60 per cent and allowing access to more new patients. For patients with pituitary disease, St. Joseph’s created the One-Stop Pituitary Clinic in collaboration with specialists across the city. Through a central referral process, initial lab testing, endocrinology consult, visual field testing and neuroophthalmology consult are arranged on the

Dr. Gillian Kernaghan.

same day. In the past, patients with pituitary disease from across the region made on average 2.4 trips to London travelling a total distance of about 300 km. The total number of visits has since dropped to one and the average distance to 116 km. In November 2013, St. Joseph’s and about 80 regional health care stakeholders from a wide variety of sectors gathered for the London Partnering in Health Care Transformation/Health Links event to discuss ways to better serve high-needs patients at this time of rising health care costs. Since then, the province’s Health Link model launched in London of which St. Joseph’s is a committed partner. Health Links encourage greater collaboration between family care providers, specialists, hospitals, long-term care, home care and other community supports. The goal is for patients to spend less time waiting for services, improve patient transitions within the health care system, and have care providers working together to develop solutions that address each patient’s specific needs. The approach is a good fit with our own

goals of integrated, interprofessional care, not only at St. Joseph’s Hospital but across the organization at Parkwood Hospital, Regional Mental Health Care, Mount Hope Centre for Long Term Care and the Southwest Centre for Forensic Mental Health Care. We are creating synergies between experts from various fields and bringing them together to collectively focus on patient needs. Through our new Centre for Cognitive Vitality and Brain Health, for example, geriatricians, psychiatrists, physiatrists, psychologists, scientists and others are working collaboratively to provide care and improve outcomes for those with mental illness, dementia, brain injury, and other neurological conditions. With an enduring commitment to rise to new challenges and a willingness to go in new directions, the ultimate goal is to earn complete confidence in the care we provide and make a lasting difference in the quest to live fully. It’s to create experiences H like that of Pat Schmidt. n Dr. Gillian Kernaghan is President and CEO, St. Joseph’s Health Care London.

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ontending with severe allergies and asthma for decades now, Pat Schmidt is a regular at St. Joseph’s Hospital in London, visiting outpatient clinics as often as every two weeks. Here, she receives specialized care to control her symptoms, but, if you ask her, that’s not what impresses Pat most about the clinics. “I am treated like family. They all know my name and whenever anyone sees me, they always have a smile and say hi and ask how I am. When I call in for an unscheduled appointment, they accommodate me. If I ever have questions, they make sure they get the answers for me and they take the time to talk to me about my concern.” Pat’s experience – the personal touch and education she receives, the focus on supporting self-care, and integrated care that meets her varied needs – are the goals for chronic disease management at St. Joseph’s Hospital.

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16 Focus

SURGICAL PROCEDURES/TRANSPLANTS/ORTHOPEDICS/REHAB

New report on patient advisory councils By Anila Sunnak he Change Foundation’s latest report (April 2014) investigates the evolving function and best practices of Ontario’s hospital-based Patient/Family Advisory Councils (PFACs): one mechanism some hospitals are using – among other approaches – to advance patient/family engagement and patient-centred care. Despite the increasing number of councils being created across Ontario, little was known about them prior to this review. The Foundation is an independent, Ontario health care think tank which uses research, policy analysis, and public engagement to improve people’s health care experience as they move in, out of, and across the health care system over time. The review is well-timed. Ontario is shifting toward patient-centred care under the Excellent Care for All Act – excellent news for all – and the report provides guideposts on the road ahead. The tangible lessons and leading examples it presents are useful for hospitals setting up a council, for hospitals further along in the process who want to empower their councils even more, and for potential adaptation in other sectors. “This preliminary review builds on The Foundation’s strategic work to help advance a patient-centred system in Ontario, by focusing in on the important cultural shifts underway within hospitals. It’s clear that while still evolving, hospital PFACs are engaging Ontarians to become active partners in their own care, to shape how care is organized, delivered and ex-

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“Patients and families bring a unique perspective. It’s a perspective that no one else can have… you see the inner workings of the hospital from the inside out. You might have these really great policies and procedures on paper, but how does that actually roll out and what is the impact?” Julie Drury, a Family member from Children’s Hospital of Eastern Ontario. perienced. Leading PFACs also said that when hospital leaders embed patient and family centred care into their strategic plans, they create an enabling environment for patient/family councils to truly succeed by moving policy into practice,” says Cathy Fooks, CEO ,The Change Foundation. The 3-part report aims to guide, connect and inspire by presenting thematic findings with examples of challenges and successes; quantitative data; and listings of PFAC initiatives, with contact information. The Foundation interviewed 64 patients, family and staff from 29 Ontario hospitals about the functioning and impact of their PFACs. There were two interview guides, one for patient and family members, and the other for staff members. The Foundation asked questions like “What were the council’s roles in relation to the hospitals? How are they structured? What is their impact to date? Is the PFAC an effective model for patient/family engagement?” The resulting snapshot provides valuable insights into emerging themes, challenges/successes,

and best practices associated with various aspects of PFACs. Part 1: Emerging Themes presents thematic findings from the Ontario-wide telephone interviews. The report notes that councils range in terms of years of experience – some have been operating only for a few months while others have been around for 20 years. Seasoned PFACS (10+ years) tend to exist in specialty centres such as children’s hospitals and mental health institutions. Part 2: What the Data Tells Us features data graphs from key close-ended questions about PFAC operation, structure, purpose, governance and overall impact. Some top findings: (96%) of patients/families said they participated as equals with staff, and lauded the ensuing collaboration; and (89%) reported interaction with senior hospital management about the council’s work indicating organizational support. Part 3: Examples: What the Councils Changed is especially useful for those leading or participating in a hospital PFAC. This part lists specific PFAC ini-

tiatives with key contacts to facilitate dialogue/collaboration across the sector. The five key types of initiatives spearheaded by councils (with examples) include: 1) Changes to hospital policy and programs: e.g., CAMH’s – Right to Daily Access to the Outdoors for mental health clients. 2) Support infrastructure planning, redesign, signage and wayfinding: e.g., St. Joseph’s Healthcare Hamilton’s tracking board for patients undergoing surgery/ recovery. 3) Food/nutrition: eg., Bluewater Health's collaboratively developed policy allowing families to bring safe/nutritious food for patients from home. 4) Staff orientation/public education: e.g., Kingston General Hospital’s patient advisors integrated throughout every committee dealing with major decisions, including staff hiring. 5) Creation/updates to hospital informational materials: e.g., Holland Bloorview’s collaboration with families to make all educational information accessible/userfriendly. The Change Foundation plans future partnerships to learn more about similar advisory bodies in other health care sectors. The Change Foundation recognizes that this review touches only the surface of this fast evolving area, so we welcome your input on this report. Tell us if we missed anything, or share your PFAC experience with us. Please email: shylmar@ H changefoundation.com n Anila Sunnak is a Communications Specialist at The Change Foundation.

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Travel 17

5 of Europe's

best luxury destinations for the summer

Mykonos

By Diana Herst here is a great variety to be found in Europe: from mountainous sceneries to stunning beaches, from bustling cities to picturesque villages. The fact that there is something for every budget makes it a great continent to travel to; however, there are destinations in Europe that mostly cater to those who seek luxury and opulence. Lavish hotels, fine dining restaurants and high-end shopping, combined with white, sandy beaches, make these destinations the ultimate place to go to in summer. Let’s take a look at some of Europe’s best luxury destinations.

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Monaco

If you have the desire to be surrounded by the jet set along the French Rivièra, Monaco might be the place for you. Multi-millionaires show off their fast sports cars and luxury yachts in the harbor, while tourists splurge on fine dining and high-end shopping. Thankfully, there is also a plethora of sightseeing to do. Monaco-Ville still feels like a medieval village in many ways, as it mostly has pedestrian streets, and a guided tour through the Prince’s Palace and the Prince’s car collection will leave many astonished. Is this too much culture and history for you? Those who want to sunbathe can head for the beach and opt for a cocktail or two at one of the trendy lounge clubs afterwards.

Ibiza

When it comes to traveling to Ibiza, you can make it as expensive as you would like. While there are many options to make a holiday to Ibiza affordable, spending a lot of cash is not difficult either. Ibiza has countless luxury boutique hotels with stunning views, as well as trendy restaurants and clubs where Ibiza’s jet set is seen after sunset. It is a popular hotspot for those in the movie, music and fashion industry and people come here to flaunt. Even though Ibiza’s jet set scene is prominent, the island also attracts a wide variety of people who enjoy things like water sports, music festivals, great food and relaxation. www.hospitalnews.com

Saint-Tropez

Before the 1950s, Saint-Tropez was a serene fishing town that no one found worth visiting, but when Brigitte Bardot came here for her movie And God Created Woman, this instantly changed. Since then, the town has attracted many millionaires and large numbers of tourists, who gasp at the wealth that this town showcases with its luxury yachts in the harbor, chic boutiques and fine dining restaurants. For a small town like Saint-Tropez, the possibilities are endless. On warm summer days, the beaches with crystal clear waters are an easy occupation, but the cobblestone streets of Saint-Tropez and its neighboring towns are a charming variation of scenery. History lovers adore this jet set fishing town because of its historical and religious sights.

Capri

Although tourism to the Italian island of Capri has grown tremendously over the past decades, it has remained charming. In the 1950s, the island transformed into a jet set destination after Jackie Kennedy and Sofia Loren visited, but compared to other luxury destinations in Europe, Capri is modest. Luxury yachts and expensive sports cars are seen sporadically; however, luxury is certainly present. Capri is home to highend shopping, and the excellent dining scene makes the island a favorite for foodies. For the young and sophisticated, there is a lively night scene in Capri Town, and the mountainous heart of the island is a way to incorporate some activity into a relaxing holiday.

Mykonos

Over the past years, the Greek island of Mykonos has gained a reputation of a party island, but it is in fact a holiday d estination for the international jet set. In the 1960s, Jackie Kennedy Onassis and Aristotle Onassis frequented here and since then, Mykonos has become a favorite destination for high-end fashion designers and celebrities. With stun-

ning beaches, a trendy night scene and some of the finest restaurants of Greece, Mykonos is a hotspot in summer, but even in winter it attracts plenty of tourists. Cooler seasons on Mykonos are generally sunny and warm, compared to other parts of Europe, and it is a great

way to benefit from Mykonos’ glamour at H a lower price. n Diana Herst is a freelance writer. This column appeared on www. aluxurytravelblog.com. It is reprinted with permission.

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18 Focus

SURGICAL PROCEDURES/TRANSPLANTS/ORTHOPEDICS/REHAB

Death and organ donation

Continued from Cover

By Dr. Sam Shemie rgan donation saves lives. The majority of life-saving and life-preserving organ transplants occur through a process known as deceased donation, whereby organs are removed after death has been determined. Deceased organ donation can therefore occur when a person has been declared dead because either their heart or brain has completely and permanently stopped working. Guidelines for both forms of deceased donation are in place and have been for many years in Canada. These guidelines include full disclosure and informed consent, the separation of duties of medical teams who are caring for critically ill patients from medical teams who perform organ transplantation, and rigorous standards for determining death, which must be performed by two physicians who are independent of transplant teams. As well, the guidelines stipulate that no transplant surgical procedures may start before a patient has died. It is important to understand that after death is determined and life has ended, the brain is no longer able to function. Despite how recent death is, donors are not able to experience any pain or suffering during the donation process. Of course any discussion about death should never minimize the profound, emotional, psychological and spiritual impact that the loss of a loved one has on family and friends. Discussions about death are

O

Dr. Sam Shemie in the PICU at Montreal Children’s Hospital. difficult given the emotional and sensitive subject matter. There are philosophical, religious, and cultural differences when it comes to defining death and a lack of understanding and awareness, not just amongst the public, but health professionals as well. Despite these challenges and various dimensions, it is important to understand how death remains first and foremost, a biological process. Over the last 50 years, the advances in medicine, biology, and technology have been remarkable and have helped us in

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two major ways: by saving patients and by helping us understand the biology of life and death. The specialties that have led to improving our understanding of this domain include: cardiopulmonary resuscitation and physiology; cardiac surgery and cardiopulmonary bypass; ICU-based life support; extracorporeal support and extracorporeal membrane oxygenation (ECMO); cell biology and organ donation, preservation and transplantation. These advances have been truly astonishing in the collective effort to save lives. They

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HOSPITAL NEWS MAY 2014

have also informed, and complicated, how medicine and modern society understands what it means to be alive or dead. In the ICU, during the treatment of life-threatening illnesses, sustaining life is based on delivering oxygen and nutrients to cells, specifically, to the mitochondria of the cells. This process provides energy for metabolic processes required for life. Trillions of cells are grouped together and make up our organs – all distinct structures with very distinct functions. Vital organs have basic functions; the lungs provide oxygen to the blood, the heart is the pump that circulates the blood containing oxygen, the liver metabolizes and the kidney filters. The role of acute care and ICU professionals is to treat organ failure by recognizing life-threatening conditions and to intervene with life-sustaining treatments to prevent death. Technologies that support vital organs can sustain life in order for time or treatment to reverse the life-threatening condition. These complex, resource intensive and arduous treatments are extraordinarily successful, with survival rates around 98 per cent in children and 85 per cent in adults. These treatments are fundamentally directed to provide oxygen delivery to the body. Without oxygen delivery, cells and organs stop working. The dying process, which can be interrupted by life-saving intervention, is sequential and predictable. In general, death occurs by one of three mechanisms: 1) A primary respiratory illness/event causes breathing to stop, resulting in a fall in oxygen levels in the blood, which finally causes the heart to stop pumping; 2) Primary heart disease such as a heart attack – the heart arrests and cannot pump; and Continued on page 19 www.hospitalnews.com


SURGICAL PROCEDURES/TRANSPLANTS/ORTHOPEDICS/REHAB

Focus 19

Death and organ donation Continued from page 18

3) Catastrophic brain injury – the brain stops working, the brain’s control of breathing is lost, breathing stops, oxygen drops and the heart stops beating. Remarkable advancements in technologies and transplantation permit the interruption of this dying process by supporting or replacing failing organs, with the assumption that time and/or treatment will reverse the disease. Organs can now be supported by machines such as artificial hearts (ventricular assist devices), artificial kidneys (dialysis machines or blood filtration systems), breathing machines that effectively push oxygen into the blood stream or artificial lungs that completely replace lung function. These treatments and technologies can be used inside the body or deployed outside the body. Examples of extracorporeal, or outside of the body technologies, include ECMO (extracorporeal membrane oxygenation) for respiratory failure or cardiac arrest and heart-lung bypass machines used for open heart surgery. It is an incredible achievement to be able to provide patients access to these complex heart/lung/kidney machines that can pump and circulate, oxygenate and filter blood. They can completely replace the total arrest of heart/lung/kidney function. If that is the case, then how does one die? These technologies serve as so called ‘bridges.’ If the underlying life-threatening organ failure can improve with time or treatment, these technologies are ‘bridges to recovery.’ If the failing organ cannot recover, they may become ‘bridges to transplant,’ but only if an organ transplant becomes available in time. In many unfortunate cases, when recovery is not possible and transplant is not an option or is unavailable, these technologies effectively become onerous ‘bridges to death.’ In this case, the technologies allow us to keep organs of the body working artificially, even when all effective treatment options are exhausted. Unfortunately, this is a circumstance many families find themselves in when a loved one has a non-recoverable illness and, based on the expert opinions of the health care team, must choose whether it’s time to stop life-sustaining treatment. In ICU’s‘ across Canada and worldwide, a decision to withhold and withdraw lifesupport is the most common event preceding death. The goals of care change from life saving to comfort measures. In Canada, it is a decision that can only be made by the family, consistent with the wishes and values of the patient. The vast majority of these deaths are not eligible for organ donation and in all cases, it is a decision made independent of consideration of organ donation. The one organ that cannot be replaced or supported is the most complicated and important – defining who we are and what we are – the brain. The brain is responsible for our ability to breathe independently. It controls consciousness, awareness, sensation, movement, thinking, feeling and acting as well as brainstem reflexes and interaction/exchange of information with our environment. Most treatments, in supporting or replacing failing organs, are dedicated to preserving or restoring brain function. Regardless of the severity of the brain injury or the degree of the coma, the body and the organs can be kept alive indefinitely by replacing breathing with a machine (one that provides oxygen to the blood in order to keep the heart beating) and attentive ICU care. There are many diseases that cause catastrophic brain inwww.hospitalnews.com

juries such as stroke, trauma, oxygen deprivation, and brain hemorrhage. If there is any degree of residual brain function, no matter how minimal, the patient is still alive and decisions to start, stop, or continue life-sustaining treatments are made by the family based on the advice provided by the medical team. However, the most extreme form of brain injury is brain death. It is better understood as ‘brain arrest,’ which is the complete and permanent cessation of all clinical functions of the brain. All functions of the brain have been lost and they will never resume – no ability to breathe independently, no capacity for consciousness, no awareness, no sensation, no thinking, no feeling, no acting, no brainstem reflexes and no interaction/exchange of information with the environment – the person has died. It is important to note that the majority of these cases are associated with complete arrest of blood flow to the brain. Organs that do not have oxygen delivery cannot function. In accordance with deceased donation guidelines, in the presence of a clear cause of the brain injury, after reversible or confounding conditions are carefully excluded, and a detailed neurological examination is performed by two physicians separate from the transplant team, the person is declared dead by neurological determination. However, as long as the body remains on a breathing machine, the remaining organs can retain function. Once the determination is made, the person is medically and legally dead, the breathing machine will be stopped and the option for organ donation is offered to the family. Confusion has arisen with recent media cases of brain death in pregnancy. After brain death it is possible to sustain organ function with mechanical breathing, infection control, hormone replacement and diligent ICU care for long periods of time to allow for fetal development to mature birth. Effectively, these pregnant but brain dead mothers serve as life support systems for the baby, similar to extracorporeal life support systems such as ECMO, until the fetus is viable. It does not change the medical and legal fact that the mother remains a dead person with an artificially sustained body to allow the baby to be delivered, after which organ support systems are terminated.

Canada is a world leader in establishing the ethical and medical practices on the determination of death and donation. Death that is correctly diagnosed by neurological criteria is not reversible – there is no chance of recovery of brain function. Rare reports of ‘miraculous recovery’ of such patients are misleading – these cases are patients who did not have the full diagnostic criteria for the neurological determination of death applied by experienced physicians. In Canada, the requirements across the country are uniform and include diagnostic requirements, clinical checklists and a minimum of two physicians with experience and expertise to prevent the possibility of error.

In public surveys, more than 90 per cent of Canadians support organ donation and transplantation. There are over 4,000 Canadians waiting for an organ transplant and in 2012, 230 Canadians died waiting for an organ transplant while more than 2,200 transplants were performed. In Canada, if you require a life saving organ transplant, you have a 30-40 per cent chance of never receiving one. While brain death is a principal source for organ donation, donation after circulatory death (DCD, cardiac death) has reemerged as an option in Canada. DCD has

In ICU’s‘ across Canada and worldwide, a decision to withhold and withdraw life-support is the most common event preceding death.

been a well-established form of donation in many countries for many years – like the US and the UK – and accounts for 20 -50 per cent of deceased donation in wellestablished regions. This form of donation is still relatively new in Canada, as we have taken a prudent and planned approach. In response to the Canadian Transplant Community asking ‘why is Canada not doing DCD’, the Canadian Council for Donation and Transplantation (now Canadian Blood Services) sponsored a forum in 2005, hosting 120 national and international experts. During the forum, rigorous discussions were had about whether or not Canada should perform DCD. The answer was yes and, together, they created the recommended guidelines that are now available to hospitals across the country. That was nine years ago. As part of this expert consensus, public and professional surveys showed strong support for DCD and trust in the system. Since 2006, there have been more than 360 Canadians who donated organs after circulatory (cardiac) death, and more than 1,000 transplants would not have occurred if this donation option was not available to Canadian families. Ontario has been a DCD leader, accounting for 75 per cent of donors in Canada. DCD programs have been implemented in British Columbia, Edmonton, Ontario, Quebec and Nova Scotia. Manitoba and Saskatchewan are in the process of developing DCD policies. The goal of every ICU team is to save lives. They work closely with the family of critically ill patients, making consensual decisions about starting, continuing and– only when a life cannot be saved – withdrawing life-sustaining treatments. The dying patients who are candidates for DCD are generally patients with catastrophic brain injury, not brain dead but with some residual brain function and a very poor prognosis for meaningful recovery. Their families have made the decision to stop life sustaining treatments. In these cases, the ICU teams manage end-of-life care, ensuring relief of suffering, comfort and dignity. For patients who are candidates for organ donation and whose families have given their consent for donation, it is also the

sole responsibility of the ICU team to determine death according to national organ donation guidelines. In the case of donation after cardiac death, it is required that two physicians must be present to monitor and document the absence of a pulse, breathing and blood pressure for a period of no less than five minutes. The transplant team has no role in any of these duties. The brain stops working prior to or within 20 seconds after a cardiac arrest so it is impossible for donors to experience suffering. In medicine, death is defined as the complete and permanent cessation of heart function or brain function. Canada is a world leader in establishing the ethical and medical practices on the determination of death and donation. In May 2012, in collaboration with the World Health Organization (WHO) and international experts who care for critically ill patients who may die, Canadian Blood Services organized and hosted a meeting as part of the first phase in the process for the development of International Guidelines for the Determination of Death. The report from this meeting has been published recently in the journal Intensive Care Medicine. The report supports current practices in Canada and reaffirms Canada’s leadership in ethical and medical conduct and procedures regarding death determination. The loss of a loved one is tragic. Organ donation is wonderful act at the worst time – the juxtaposition of an unavoidable death in a willing donor to a preventable death in a transplant recipient. This gift, this benevolence, is predicated on the public trust of the health care system, based on the first and foremost priority to save the life of the ill and injured whenever possible. If not possible, then we care for patients at the end of their life and when possible, provide H the option of organ donation. n Dr. Sam D. Shemie, MD works in the Division of Critical Care, Montreal Children’s Hospital, McGill University Health Centre where he is Medical Director of the Extracorporeal Life Support Program and is a Professor of Pediatrics, McGill University; Loeb Chair and Research Consortium in Organ and Tissue Donation, Faculty of Arts, University of Ottawa and Medical Advisor, Donation, Canadian Blood Services. The views expressed are those of the author alone and do not necessarily represent the decisions, policy or views of the Montreal Children’s Hospital, McGill University, University of Ottawa or Canadian Blood Services.

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20 Focus

SURGICAL PROCEDURES/TRANSPLANTS/ORTHOPEDICS/REHAB

Rehab program gets patients home sooner By Debbie Kwan

unnymede’s Low Tolerance Long Duration (LTLD) Rehabilitation program is playing an increasingly important role in the health care system. Since the program’s inception in April 2012, it has helped over 400 patients – who were occupying a bed as an alternate-level-of-care (ALC) patient in an acute care facility – regain the functional skills necessary for day-to-day living, mobility and independence to return home. ALC is a classification given to patients who are ready to be discharged but remain in hospital as they await transfer to a more appropriate setting to receive the next phase of treatment. Patients would be designated ALC, for instance, if they are staying in acute care but are actually waiting for – and in need of – a bed in rehabilitation that is not yet available. According to the Ontario Hospital Association, approximately 2,300 ALC patients occupied acute care beds in the province as of March 2013. Of these, 25 per cent were waiting for a regular rehabilitation bed or a complex continuing care bed. In addition to freeing up beds that may be needed by more acute patients, reducing the prevalence of ALC stays benefits patient safety and wellbeing. Patients who stay in acute care longer than medically necessary may be at risk of declines in physical and mental health due to decreased mobility. Sometimes known as slow stream rehab, LTLD rehab serves patients who, because of their level of disability, need slowerpaced rehabilitation therapy to maximize their abilities after surgery, illness or injury. For example, a senior who has suffered a hip fracture and has a weakened tolerance for physical activity might benefit from this less intensive approach to rehabilitation. Runnymede’s LTLD Rehab program was formed in collaboration with St. Joseph’s Health Centre and has been successful in transitioning ALC patients waiting at St. Joseph’s for LTLD rehab to a more appropriate care setting at Runnymede. To date, the results have been extraordinary. As of September 2013, St. Joseph’s has seen a 3.4 day decline in the average length of stay of an ALC patient waiting for LTLD rehab. Further, in the last quarter Runnymede has reduced the average length of stay of an LTLD rehab patient to 55 days, which is significantly lower than the provincial average of 90 to 120 days. This means that the LTLD Rehab program has been instrumental in easing healthcare system pressures by freeing up acute care beds and efficiently transitioning patients to an environment that is more congruent with their clinical needs. A patient can be classified as ALC at any point in their journey through the health care system. If a patient in the LTLD Rehab program has reached their rehabilitation goals at Runnymede and is ready to return to the community but can-

R

The LTLD Rehab program has reduced the average length of stay of a patient to 55 days.

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not do so, that patient would also be designated as ALC. A patient might not be able to return home, for instance, if they are on a waiting list for a long-term care facility or if their home is being renovated to accommodate their needs during their hospital stay. To mitigate factors that may prevent patients from returning home or to the community sooner, as well as minimize the number of ALC patients at the hospital, Runnymede recently implemented an ALC Avoidance Strategy. Formed in partnership with the Toronto Central Community Care Access Centre (CCAC), the ALC Avoidance Strategy includes policies, education and increased reporting and accountability to support the discharge planning process. In addition, a team consisting of Runnymede and CCAC staff participate in biweekly rounds to discuss each current ALC patient. These consultations enable the team to identify barriers to discharge, assess the patient’s community support needs and develop action plans to facilitate the patient’s safe and smooth transition to the community.

The ALC Avoidance Strategy includes policies, education and increased reporting and accountability to support the discharge planning process “Our ALC Avoidance Strategy takes a proactive, preventative approach,” says executive lead of the strategy and Vice President, Clinical Programs, Lisa Dess. “Through early identification of patients who may potentially become ALC and taking necessary steps to address factors that might prevent their anticipated discharge, we are able to ensure each patient receives the most appropriate care in the most appropriate setting.” The Ontario Hospital Association predicts that as the population ages, the need for rehabilitation services will likely increase. A report by the Canadian Orthopedic Care Strategy Group revealed that the number of Canadians with musculoskeletal disease is expected to rise with the aging baby boomer population, from 11 million in 2007 to 15 million in 2031. Since orthopedic conditions such as knee and hip fractures are the most common reason for inpatient rehabilitation, it will be increasingly important to ensure patients are able to access this type of specialized care and rehabilitation therapy that we provide at H Runnymede. n Debbie Kwan is a Communications Associate at Runnymede Healthcare Centre. www.hospitalnews.com


Healthcare Technology 21

Revolutionizing healthcare with personalized medicine By Bob Elliott

magine a world where every physician will be able to compare, in a keystroke, their diagnosis with the data of thousands of other patients with the same symptoms and demographic and lifestyle makeup. Our access to information today is unprecedented. We have smartphones with us everywhere we go and we can search anything online in a second. In the health care industry however, a comparable access to information doesn’t exist. The fact that we can’t search any medical information immediately, the same way we use Google in our daily lives, means doctors and physicians are being held back from providing the highest level of care. The health care industry is evolving, however. The changes are not sudden and spectacular, but steady and evolutionary in nature. We’re seeing a slow transition take place towards a more connected health care system. Most recently, the British Columbia Centre for Excellence in HIV/AIDs announced that it is pioneering new technology to treat patients with immediate and personalized care. This is the first initiative of its kind in Canada. Once the technology is installed, the Centre will be able to quickly identify a patient’s unique strain of the virus by rapidly analyzing massive amounts of data, and provide a treatment that is personalized to the patient. This means that patient care is greatly improved as treatment is provided quickly, which in turn can help lower health care costs.

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What is personalized medicine?

We are able to provide personalized medicine when medical decisions, practices, and products are being tailored to the individual patient. A classic example of how personalized treatment has been hugely successful is the discovery of Trastuzumab (Herceptin), history’s most successfully targeted cancer drug. It is prescribed to treat breast cancer induced by over expression of a specific gene (HER2) and is a major pharmacogenetics success story. The drug can shrink tumors, slow disease progression, and increase survival. And unlike most chemotherapy drugs, trastuzumab is a

Innovative laser procedure improving patient experience nlargement of the prostate, or benign prostatic hyperplasia (BPH), is a condition that affects nearly half of all men over 50 and close to 90 per cent of men over 80 worldwide. It’s a condition that causes urinary complications that can include a weak flow, the sudden feeling of urgency to urinate (often in the middle of the night), inability to fully empty the bladder and incontinence, among other symptoms. Prolonged BPH without treatment can lead to urinary tract infections, inability to pass urine and even bladder or kidney damage. Recent technological advancements have led to the introduction of a therapy that is both improving treatment and saving health care costs. This procedure – called photoselective vaporization of the prostate (PVP) involves the use of a laser to quickly vaporize and safely remove prostate tissue. PVP is a minimally invasive procedure that offers many benefits including virtually no blood loss, a fast recovery time and the fact that it can be performed in an outpatient setting. In addition to patient benefits, a 2013 study by Health Quality Ontario, an On-

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tario government agency that evaluates the effectiveness of new health care technologies, examined the PVP procedure. The study found PVP to be cost-effective, providing clinical benefits to patients at a lower cost to the health system. The results also indicated that patients recovered faster with fewer side effects and complications following surgery. Were it to be deployed across Ontario, the HQO study estimates an annual cost saving of $14M and 28,213 days saved in hospital bed occupancy. The PVP procedure “has a lower incidence of post-operative complications and requires less hospitalization” says Dr. Paul Whelan, a urologist at St. Joseph's Hospital, Hamilton and contributor to the HQO study. “And with an aging demographic, it's also good for the future of Ontario's healthcare system” he adds. PVP is currently in use in over 60 hospitals across Canada, but there are many opportunities for its expansion. It’s just one example of a minimally invasive procedure enabled by medical technology that can help deliver better treatment to patients, while contributing to the sustainability of H our health care system. n

targeted therapy that kills only cancer cells while leaving healthy cells intact. We now know through genomics and testing for this mutation that this drug is only effective in roughly 25 per cent of breast tumors. Knowing this and using it only in the right patients generates a tremendous savings of health care dollars. The treatment of broad populations with regimens that do not benefit most patients is not economically sustainable and is increasingly less necessary. The use of genetic information has played a major role in the journey towards personalized medicine. Decoding genomes will increase our understanding of the genetic makeup of diseases, which could speed up the development of new drugs as well as determining more targeted treatment therapies.

Using personalized medicine to treat HIV/AIDs in Canada

The British Columbia Centre for Excellence in HIV/AIDS at St. Paul’s Hospital, British Columbia, has teamed up with a local technology startup company, PHEMI Health Systems, and SAP, to deliver personalized medicine to HIV/AIDs patients based on the genetic signature of the virus that infects each patient.

Dr. Paul Terry, CEO of PHEMI Health Systems, offers a simplified view on what this means for health care professionals: “Over 70 per cent of health care information is unstructured and difficult to mine for relevant insight using traditional methods. What we intend to offer health care professionals, essentially, is the ability to turn physician letters and lab results into searchable information, thereby helping to unlock vast amounts of new information for clinicians, analysts and researchers.” “We’re changing the face of treatment for HIV and AIDS,” explains Dr. Julio Montaner, director of the British Columbia Centre for Excellence in HIV/AIDS. “This technology will be invaluable to the lives of our patients. We will be able to quickly treat patients by delivering personalized medicine based on their unique strain of the virus. This will help us save time and money while also significantly decreasing the number of new HIV and AIDS cases. For the first time, we shall have access to vast amounts of information and get answers immediately thanks to technology from PHEMI and SAP.”

The future of medicine

Advances in genomics are improving our ability to predict and prevent adverse drug reactions, and mitigate disease conditions. Personalized approaches to health care will help eliminate the trial-and-error inefficiencies that inflate health care costs and undermine patient care. The hope is that genomic insights will reduce the time it takes to find a treatment down from weeks to minutes, bringing the most effective therapies to patients faster, and improving the lives of people surviving with chronic disease. The bold action taken by the BC Centre for Excellence is a great proof point that forward-thinking Canadian healthcare companies can lead the world in this industry. Doctors and researchers are now envisioned to have a much faster way of treating patients. Working together, we plan on lowering healthcare costs by speeding up treatment plans, improving patient care and addressing chronic disH ease as a whole. n Bob Elliott is Managing Director for SAP Canada.

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MAY 2014 HOSPITAL NEWS


22 Healthcare Technology

New acute care ventilator helps patients to breathe more naturally By Korinne Jew

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Providence Healthcare Speech-Language Pathologist Kristin Hayes uses an iPad dysphagia app to help a patient learn more about the effects of a stroke on swallowing.

Integrating iDevices with rehabilitation By Jennifer Joachimides and Marcia Curry rovidence Healthcare’s iPad project began when Occupational Therapists identified an opportunity to advance therapeutic approaches in stroke and neuro rehabilitation by incorporating the use of technology in patient care. In reviewing current literature, they found that iDevices are becoming integrated more into the rehabilitation process thanks to both their versatility as well as the greater use of technology by patients and their families. A team of Providence Occupational Therapists and Speech-Language Pathologists researched mobile apps for use with stroke and neuro patients, later developing a process for incorporating the use of mobile tablets into patient care. Three iPads donated at the Providence Healthcare Foundation’s 2012 Silver Ball were implemented within Providence Hospital’s Stroke and Neuro Rehabilitation program for both inpatients and outpatients. The iPads have since been used regularly in speech and occupational therapy sessions to help patients with their thinking, perception, speaking, understanding, reading and writing, and to help them learn more about stroke and its effects. The devices have also helped other team members, including physiotherapists and nurses, provide visual feedback to patients through photos and videos. Over a four-month trial, 98 per cent of patients using the technology reported HOSPITAL NEWS MAY 2014

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finding the iPad helpful and 100 per cent reported they would try it again. Patients identified that the iPad could help them with practicing for return to driving, keeping the mind sharp, making the left hand better, having better awareness of what is happening with swallowing, practicing spelling, preparing for going home and continuing to work on speech therapy independently. Therapists appreciate the iPad’s potential for augmenting current therapeutic practices with engaging apps and for providing education in a visual way that is easily understood. For example, a dysphagia app shows patients with swallowing problems what it looks like when they

aspirate (have food or liquid go into their airway) using slow-motion video. Next steps for the project include enabling patients to use the devices independently between sessions in order to practice what they have learned in therapy, and continuing to explore new apps and creative ways to use the devices to help our patients work toward their H rehab goals. n

ovidien, a global provider of health care products and innovator in patient monitoring and respiratory care devices, announced Health Canada approval of its Puritan Bennett™ 980 ventilator. The new acute care ventilator from Covidien – designed to be simple, safe and smart – helps enable patients to breathe more naturally through some of the most innovative breath technology available. “We are excited to introduce our nextgeneration acute ventilation platform, the Puritan Bennett 980 ventilator,” says Teresa Mattarelli, Vice President and General Manager, Canada, Covidien. “We believe this ventilator will provide health economic solutions by naturally helping to reduce patient dependency on ventilation.” The Puritan Bennett 980 ventilator features a range of software capabilities, including Proportional Assist™* Ventilation Plus (PAV™*+) and Leak Sync software, which can help clinicians achieve the most critical goal: reducing time on the ventilator versus traditional volume control mechanical ventilation. Patients on mechanical ventilation are often sedated to ease agitation and help them tolerate breath support and other medical interventions. The Puritan Bennett 980 ventilator features advanced synchrony tools that help clinicians set the ventilator to adapt to their patients’ unique needs and help provide the appropriate level of support throughout the breath. Reducing patient-ventilator mismatch may reduce the need for sedation and stop the vicious cycle between sedation, asynchrony and muscle weakness. The new ventilator features a customizable display and intuitive screen navigation, and software to enhance patient safety and clinical workflow, including: • NeoMode 2.0 software – Helps clinicians provide ventilatory support to neonates weighing as little as 300 grams by delivering tidal volumes as small as 2 ml. Continued on page 23

Puritan Bennett™ 980 ventilator

Jennifer Joachimides is an Occupational Therapist Practice Consultant and Marcia Curry is a Speech Language Pathologist with Providence Healthcare’s Stroke and Neuro Rehabilitation program. www.hospitalnews.com


Careers 23 Continued from page 22 • Leak Sync software – Detects and automatically compensates for leaks in the breathing circuit and patient interface, giving clinicians the reassurance that their patients are receiving the level of ventilatory support they need. • PAV™*+ software – Helps manage work of breathing and supports the patient’s breathing efforts, allowing

the patient to drive the start, duration and end of each breath. • Noninvasive ventilation – Allows versatile options including noninvasive SIMV and CPAP. • Bi-Level software – Permits spontaneous breathing at all times and supports biphasic or airway pressure release ventilation for extra flexibility. • Proximal Flow Sensor – Measures lower

flows, pressures, and tidal volumes right at the patient wye in neonate applications. • Volume Control Plus – Enables the patient to take spontaneous breaths to achieve a targeted tidal volume, and pressure is automatically adjusted. •Respiratory Mechanics software – Enables monitoring of key respiratory parameters for easy assessment of patient status.

• Tube Compensation software – Accurately overcomes the work of breathing imposed by the artificial airway. The Puritan Bennett 980 ventilator system is for patients ranging from neonatal to adult, and became available in H Canada earlier this year. n Korinne Jew, PhD, BSN, is the Respiratory and Monitoring Solutions Medical Affairs Manager for Covidien.

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MAY 2014 HOSPITAL NEWS


24 Focus

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HOSPITAL NEWS MAY 2014

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Hospital News May 2014 Edition  

Focus on Surgical Procedures, Transplants, Orthopedics, Rehab And National Nursing Week Supplement.

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